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D Chinitz

Publications and source records attributed to D Chinitz.

12 recordsLinked to original sources
PubMed2001

Risk-adjusted capitation. The Israeli experience.

As in a number of countries during the 1990s, Israel's health system has been undergoing structural reform based on public contracting and regulated markets. The main element of the reform was the enactment of the National Health Insurance Law (NHI), which went into effect on 1 January 1995. According to the Law, the sick funds receive risk-adjusted capitation payments, which place them fully at risk for the cost of supplying a legally mandated basket of health benefits. The paper analyses the effects of the NHI on the Israeli competitive health insurance market and discusses the major policy issues facing the Israeli system.

Capitation Fee↗
PubMed1999

Rationing: how and who?

Rationing health services, in the sense of denying care deemed of positive benefit by at least some health system actors, is a problem that politicians would like to avoid. Health policy analysis has offered a number of approaches, such as global budgeting, technology assessment, managed competition, legal recourse and public participation as palliatives for this difficult problem. Each of these approaches on its own falls short, but no country has yet designed a process for explicit rationing. Israel, in the context of its recent health reform, has gone as far as any country in this direction. However, significant political leadership will be required to frame the public discussion of these difficult issues.

Cost Control↗
PubMed1998

Evaluating the Israeli health care reform: strategy, challenges and lessons.

Evaluating the implementation of health care reform provides important information on its effect, as well as a factual basis for deciding upon mid-course modifications. Although researchers in various countries are addressing the impact of reform, only few governments have initiated a structured, planned evaluation to accompany reform efforts. In Israel, the 1995 National Health Insurance Law earmarked 0.1% of the health care budget for research on the law, coordinated by the National Institute for Health Policy and Health Services Research. This paper describes the evaluation strategy of the JDC-Brookdale Institute which is taking part in the research efforts. Implementation of the evaluation strategy and the challenges of evaluating a major reform of the health system are discussed. The evaluation strategy combines elements of formative and summative evaluation using a 'case study' approach which seeks to integrate in-depth understanding of the changing health system and of health care provider's organizational behavior, with a variety of outcome measures. The Israeli case provides support for the proposition that an integrated approach to evaluating health reform provides a better understanding of the subject under review and thus a better basis for making useful recommendations to policy makers. In addition, such an approach enhances the validity and credibility of the data and thus the probability of making an impact, which is a main objective of formative evaluation. Examination of the Israeli case, provides important insights about evaluation of health system reform, and may benefit researchers in other countries attempting to evaluate health care reform.

Evaluation Studies as Topic↗
PubMed1998

Health system reform and the elderly: the case of Israel.

Following the implementation of the National Health Insurance Law in January 1995, major changes have taken place in the provision of health services by Israel's sick funds and the way these services are funded. This article presents the principal changes that have occurred and assesses their impact on those aged 65 and older, using findings of a survey conducted one year after the law's enactment. While the findings show that the elderly's situation has improved in some areas, they also raise concerns that the elderly are having difficulty navigating the reformed health system and that they are not benefiting from the new competition among the sick funds.

Aged↗
PubMed1995

Israel's health policy breakthrough: the politics of reform and the reform of politics.

After decades of attempts, Israel has enacted a national health insurance law and begun to substantially change its health care system. I explore the conditions that enabled final passage of the law in light of theories of nonincremental change in pluralist policy systems. I also discuss the implications of this policy breakthrough for links between policy subsystems, leadership, and the establishment of a new policy equilibrium.

Health Care Reform↗
PubMed1995

[Assessment by the primary care physician of his influence on the patient's hospital choice and of his own ability to evaluate hospital quality].

We report a mail survey (1993) of 677 primary care physicians employed by Israel's 4 sick funds of their influence on the patient's choice of hospital. In the light of the far-reaching changes currently taking place in the health system in Israel, factors considered by physicians in recommending a hospital were studied. About 50% reported having a high degree of influence over patient choice of hospital for elective procedures. Most reported themselves able to evaluate the quality of hospital care, especially results of clinical treatment (89%). Multivariate analysis revealed the physicians who reported a high degree of influence on patient hospital choice were men under the age of 65, independently employed by a smaller sick fund or by several sick funds. They considered themselves capable of evaluating hospital quality and were in regular professional contact with at least 1 hospital. The main factors considered in recommending a hospital were quality of its physicians and medical care, the way in which the hospital staff related to patients, and the level of equipment and technology available. Little importance was given to sick fund hospitalization policy. The survey findings had implications for primary care physicians, and for policymakers of the sick funds and the government.

Choice Behavior↗
PubMedDate not supplied

The political economy of healthy system reform in Israel.

On June 15, 1994, the Israeli Parliament voted to enact the National Health Insurance bill (NHI). The bill marks the end of a process that lasted for virtually as long as Israel's almost 50 year history. Israel's attempts at health reform began long before the current spate of reforms in many Western countries. Faced with many of the same problems of access, equity and cost control common to many of its counterparts, Israel initiated a reform process based on the recommendations of a prominent State Commission of Inquiry into the Israeli Health System (the Netanyahu Commission) which reported to the Government in 1990. The Commission's proposals were based on a diagnosis indicating that the major problems of the system stem from the lack of clarity regarding the rights of citizens to health care, the lack of a clear allocation of responsibility and accountability among government, insurance or sick funds, and providers in the system, and undue centralization of system operations. This diagnosis led to three major planks for reform: (1) enactment of national health insurance legislation granting a basic package of care to each citizen and hence bringing most of the system's finance under public auspices; (2) divesting the Government from the organization, management and provision of care; hence integrating the management of preventive and psychiatric services provided by the government with the primary and other services provided by sick funds, and granting financial and operational independence to at least government hospitals; and (3) restructuring the Ministry of Health. As is often the case in public policy, more consensus surrounds the diagnosis than the solutions. As a result, nearly four years of implementation efforts have only recently resulted in a major breakthrough. In this paper we make an effort to outline the inherent weaknesses of the Israeli health care system that have led to the crisis in the mid 1980s, summarize the recommendations of the State Commission for structural change in the system, and review the politics of implementing the recommended reforms.

Costs and Cost Analysis↗
PubMedDate not supplied

Israel--a health system in transition.

Israeli health reform, implemented after many failed attempts throughout the years, represents an attempt to solve problems of politicization, dissatisfaction, unclear roles of government and public organizations, and lack of financial accountability, while maintaining a high quality and universally accessible health system. Despite many favorable aspects, including high quality medical care, near universal insurance coverage, and high availability of services, the health system has attracted criticism since its earliest days. Israel's experience with health reform, based on a version of managed competition, is of interest to other countries considering similar policy decisions.

Accreditation↗