Myers-JDC-Brookdale Institute
Smokler Center for Health Policy
Research
PROGRAM PROPOSAL FOR 2013
June 2012
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Smokler Center for Health Policy Research
The main objective of the Smokler Center for Health Policy Research is to
contribute to the reform and development of Israel's national health services by
offering objective data and independent analysis to improve the organization,
delivery, and financing of health services.
The Center assists the government to plan, implement, and evaluate its efforts
to reform the health system, and helps health care providers and insurers to
advance their efforts to improve efficiency and effectiveness.
By combining system-wide, macro-level research with a concern for the
adequacy of health services to vulnerable populations, the Center meaningfully
engages national health policy institutions to ensure that the voices of Israel's
at-risk populations are heard among policymakers.
1. Contributing to the Planning and Monitoring of Reforms and
Other National Programs: The National Quality Measures
Program, the Mental Health Service Reform and the Reform in
Dental Care for Children
In 2013, the Center will continue to monitor the National Quality Measures
Program, which gives special attention to the effects on the health plans of
making quality data available to the public. Since the launching of the Program
in 2000, there have been significant improvements in many of the health plans’
quality measures, at a time when comparable measures of quality in the United
States have plateaued despite similar quality monitoring systems.
The Center will also continue to monitor how the health plans and physicians
use the quality data, building on a special study commissioned by the National
Institute for Health Policy and Health Services Research in which the Smokler
Center examined changes in organizational practices of the health plans to
promote quality. The Israel experience is of great interest to other countries and
several articles are being published in international journals, which share and
compare this experience.
Mental health reform. The government of Israel has recently decided to
undertake a multi-phase reform to extend the coverage of national health
insurance to include mental health care. The reform has multiple objectives,
including promoting better integration between physical health care and mental
health care, expanding the access to care among the mentally ill, and reducing
the stigma associated with receiving care.
The Center's current research program is creating a baseline for examining the
effect of the reform and is assisting in efforts to improve the system of mental
health services, regardless of the reform. Included in the list of projects below
is a significant new project for the Mental Health Services Division at the
Ministry of Health, a national survey examining the availability of mental health
services for adults and for children.
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Dental services. As part of our evaluation of the 2010 reform to include dental
care for children in national health insurance and thus transfer responsibility to
the health plans, the Center will conduct a national survey that will examine the
improvement in access to dental care following the reform. (During the first
stage, coverage is being provided for dental services for children from birth to
age 8, including full exemption of payment for preventive services. It is planned
to broaden coverage to include children up to age 14 by 2013.)
2. Issues in Health Care Manpower
For a number of years, the Center has conducted studies of health care
manpower, including studies of the reasons behind the rapid increase in
physician employment from 1990–2000, and solutions to help medical
specialties facing workforce shortages.
In 2013, the Center will assist a new specialized human-resource planning unit
at the Ministry of Health to examine different approaches to projections of the
demand for manpower in the health professions.
Mental health. The Center will continue to focus on how the planned reform in
mental health care will impact practices and patterns of care provision by
mental health professionals (psychologists, psychiatrists, and social workers),
and will study the opinions of these professionals on the transfer of
responsibility for mental health care to the health plans.
Nursing. In 2013, the Center will continue to focus on the training and
employment of nurses in Israel, through three studies. The first examines the
changes in the role of nurses in the community. The second examines the
demand for nurses among key employers. The third focuses on the professional
boundaries between nurses and physicians using neonatology wards (for
premature babies) as a case study.
At the end of 2011, doctors and employers signed a new collective agreement
that included significant incentives for doctors to live and work in the
geographical periphery of the country and in those specialties in which there is
a shortage in manpower. The Smokler Center, together with the Israeli Medical
Association and the Ministry of Health, is gearing up to study the extent to which
these incentives are having the desired effect.
3. Monitoring the Interface between Consumers and Health
Care Providers
The Smokler Center continues to be Israel’s major source of information on how
consumers view their health care services, with the regular publication of the
national survey monitoring the general population’s experience with health plan
services, conducted since the introduction of the National Health Insurance Law
in 1995.
Plans are now underway for the next round of survey, which after a 2012
decision by the Center and the Ministry of Health, will be enlarged so as to
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increase the representation of those who make more intensive use of health
care services.
We will also continue our analyses of waiting times, with the goal of defining a
unified and clear methodology for examining this complex issue. This study will
make it possible to review the situation nationwide and identify gaps in the
availability of various services.
In addition, the Center will undertake a national survey to examine the
accessibility and availability of mental health services in the community.
4. Equality in Health Care for Disadvantaged and Other Special
Populations
The Center has been asked by the Ministry of Health to assist in national
initiatives to reduce gaps in health status and health services.
Among the issues we are looking at are:
Wait times. The Institute is engaged in a study examining the differences
between geographical areas when it comes to waiting times for various services
in the community.
Center-periphery differences. There is a large gap between the services
offered in the center of the country and those in the periphery, among other
things with regard to the gaps in the quantity and quality of medical personnel.
The Institute is preparing to study the effect of the Ministry of Health’s recent
financial incentives to the health plans to invest more in the periphery.
Cultural sensitivity. Another important aspect of inequality is reflected in the
gaps between national and ethnic groups and the extent to which health
services are culturally sensitive. The Institute is conducting a study to examine
the extent of cultural sensitivity in hospital services. This is particularly important
in light of a new directive from the director general of the Ministry of Health,
which for the first time has set national standards for these services.
5. Private Health Insurance
The Center is a major source of information on private health insurance,
including those offered by the health plans as supplemental insurance and
those offered by the insurance companies as commercial insurance. The
Center continues to monitor trends in the content of these private insurance
packages and the characteristics of those who purchase these policies.
The Center is participating in various cross-national comparisons of long-termcare financing, building on earlier studies of the factors that influence whether
consumers purchase long-term care insurance and the extent to which private
long-term care insurance can help finance the care for people with long-term
care needs at home or in institutions.,
We will also continue to build on our recent reports on supplemental health
insurance plans offered by the health plans and on the financial stability in the
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market. These studies have led to the publication of additional reports,
participation in public commissions, and the publication of updated interactive
manuals on the private health insurance market. This has all been achieved
through the cooperation of the Deputy Director General for Health Funds and
Private Insurance at the Ministry of Health and the Commissioner of Insurance
at the Ministry of Finance.
6. Children, Adolescents and Health Services
Several studies focusing on the health of children and adolescents are now
underway. In partnership with the Engelberg Center for Children and Youth, the
Ministry of Social Affairs and Social Services, and JDC-Ashalim, we are
evaluating a project aimed at promoting the health of children in out-of-home
settings, with regard to nutrition, sport, dental care, and health management.
Another study conducted with the Engelberg Center, and funded by the Jewish
Federations of North America (JFNA), examines the school psychological
service at normal times and in emergencies. This service is the first layer of
public psychological services for children and it is important that the service be
utilized optimally.
This year, we are also beginning two studies examining accessibility,
availability, and satisfaction with mental health services, which include – for the
first time – questions to parents about the services provided to children and
adolescents. One of these studies is being conducted in cooperation with
Maccabi Healthcare Services, the other with the Ministry of Health.
Finally, we will conduct a national survey of how families with children have
experienced dental services in the wake of the 2010 reform that introduced
dental care for children into the healthcare package of services.
7. International Activity
The Center continues to serve as an important vehicle for cross-national
learning on health care reforms. This activity includes ongoing responsibility for
the Israel country reports to the European Observatory of Health Care Systems
and serving as the Israeli partner in the International Network for Monitoring
Health Reforms.
In 2013 as in previous years, several Smokler Center researchers will lecture at
international conferences. These lectures will revolve around topics such as
health care manpower, the formula for capitation, national reform of the health
care system, and cross-national exchange of experience.
The Center's advisory committee, composed of leading figures in US health
care and health services research, facilitates the exchange of ideas and
experience between the US and Israeli health care systems.
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List of Projects
1. Contributing to the Planning and Monitoring of Reforms and Other
National Programs: The National Quality Measures Program, the
Mental Health Service Reform and the Reform in Dental Care for
Children
Projects Ending in 2012
2114
Survey of Consumers of Mental Health Services in the Maccabi Health
Plan
Projects Continuing in 2013
Specific Studies on Mental Health
2511
National Survey of Mental Health Professionals (Psychologists,
Psychiatrists and Social Workers
2612
How the Health Plans are Mobilizing to Provide Mental Health Care
Services in an Era of Mental Health Reform
2618
An Evaluation of the Use of Psychiatric Liaison by Clalit Health Services in
40 of its Primary Care Clinics
2619
Psychological Services in Elementary Schools: Coping with Needs during
Normal Times and During Emergencies (in Cooperation with the Engelberg
Center for Children and Youth)
2620
Survey of Consumers of Mental Health Services in the Ministry of Health
Proposed New Projects for 2012
2621
How the Health Plans and Professionals Use Quality Indicators to Make
Quality Improvements – Phase ll
2. Issues in Health Care Manpower
Projects Ending in 2012
2512
Issues Regarding the Dividing Lines Between Various Health Professions
Projects Continuing in 2013
2516
Changes in the Role of Community Nurses
2520
The Demand for Nursing Manpower
Proposed New Projects for 2013
2521
Attracting Young Doctors to Work in the Periphery
3. Monitoring the Interface between Consumers and Health Care
Providers
Projects Continuing in 2013
2201
The Consumer's Perspective on the Quality of Service and Performance of
the Health Care System – a Multi-year Follow-up
2322
Measuring the Length of Waiting Lists in the Health System
2517
Out-of-pocket Payments to Hospitals
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2519
The Experience of Consumers in the Dental Health Services for Children,
Following the Reform
Proposed New Projects for 2013
Fertility Treatments and the Patients' Experience
2522
Evaluation of a Pilot to Improve the Procedures of the National Insurance
2523
Institute's Medical Assessment Committees
4. Equality in Health Care for Disadvantaged and Other Special
Populations
Projects Continuing in 2013
2116
Assisting the Ministry of Health in Developing a National Program for
Reducing Health Inequalities
2118
Cultural Adaptation of Services in General Hospitals
Proposed New Projects for 2013
2120
Cultural Adaptation of Services in the Community
1424
Continuity of Care after Discharge from General Hospitals (in cooperation
with the Center for Research on Aging)
5. Private Health Insurance
Projects Ending in 2012
2119
The Reform in Long Term Care Insurance
Projects Continuing in 2013
2701
The Development of the Private Insurance Market in Israel
Proposed New Projects for 2013
2121
Database for Health Insurance
6. International Activity
Projects Ending in 2012
2318
Dissemination of the Institute's Key Findings to the International Research
Community
2609
Serving as the Israeli Partner in the International Network for Monitoring
Health Policy Reforms sponsored by the Bertelsmann Stiftung
Projects Continuing in 2013
2608
Israel Country Report on Health Care Systems in Transition, as part of a
Series by the European Observatory of Health Care Systems
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7. Health Promotion
Projects Ending in 2012
2704 Evaluation of a Pilot Program of Health Promotion for Children Living in
Residential Settings (in Cooperation with the Engelberg Center for Children
and Youth)
Proposed New Projects for 2013
2705 Evaluation of a Program for Healthy Living
2706 Health Promotion among People with Disabilities
8. Utilization of Resources, Cost Containment and Efficiency
Projects Ending in 2012
2326
Exploratory Research in Preparation for Building an Optimal Model for
Pharmaceutical Consultation
Projects Continuing in 2013
The Impact of the New Laws Regulating the Relationships between
2327
Physicians and Pharmaceutical Companies
2328
Costs and Benefits of Services that Generate Private Health Expenditures
Proposed New Projects for 2013
2329
Assessment of the Criteria for Distributing Funds among the Health Plans
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