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The Rise of Prevention in Health Priority Setting: The Israeli Case

The Rise of Prevention in Health Priority Setting: The Israeli Case. David Chinitz, PhD Department of Health Policy and Management School of Public Health Hebrew University – Hadassah Jerusalem, Israel. International Society for Priority Setting in Health Care Boston April 24, 2010.

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The Rise of Prevention in Health Priority Setting: The Israeli Case

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  1. The Rise of Prevention in Health Priority Setting:The Israeli Case David Chinitz, PhD Department of Health Policy and Management School of Public Health Hebrew University – Hadassah Jerusalem, Israel International Society for Priority Setting in Health Care Boston April 24, 2010

  2. Outline • Musings on health care and health • Background on Israeli health priority setting • Findings • Stories • Conclusions • Implications

  3. Source: Ellencweig A 1992 Analyzing Health Systems- A Modular Approach

  4. Background • Israeli national health insurance guarantees a detailed standard basket of services • Provided by four open enrollment, guaranteed issue, uniformly priced HMOs • A specific budget increment (never enough) dedicated annually to adding services to the basket • A public committee of officials, physicians, analysts and public representatives decides • HMOs can offer supplemental insurance for items not included in the basket

  5. Public Priorities for Health Carein Israel:1997 - 2008 David Chinitz, Avi Israeli, Ilana Grau Hebrew University-Hadassah Jerusalem, Israel With support from the Israel National Institute of Health Policy Research

  6. Methods • Surveys • Ranking of health vignettes • Choosing one of several competing services (tradeoff questions) within budget constraint • Representative samples • General public • Physicians • Focus groups

  7. Table 1: Public rankings of health services over time (average scores and relative rank of vignette groups) 1997 2001 Transplants 8.8 (1) 7.87 (1) Expensive treatments 8.23 (2) 7.62 (3) Nursing care 8.1 (3) 7.39 (6) Minor problems 8.0 (4) 7.23 (7) Terminal conditions 7.88 (5) 6.77 (12) Quality of life 7.82 (6) 7.69 (2) Mental health 7.75 (7) 7.61 (4) Fertility treatments 7.69 (8) 7.5 (5) Second opinion 7.64 (9) 7.06 (8) Anxiety relief screening 7.6 (10) 6.83 (9) Addictions 7.3 (11) 6.82 (10) Cosmetic treatments 7.29 (12) 6.78 (11) Alternative medicine 7.07 (13) 6.09 (14) Cosmetic treatments ** 6.78 (14) 5.97 (15) Dental care 6.64 (15) 6.12 (13)

  8. Relative Preference of the Israeli Population for Preventive Interventions, 2008

  9. Relative Preferences of the Israeli Population for Different Health Services, 2008

  10. 2003

  11. 2003

  12. View of the Israeli Public regardingCriteria for evaluating medical technologies

  13. Israeli Public’s Agreement with Statements about Health Inequalities, by Language of Questionnaire, %, 2008

  14. Decision–makers' acquaintance with the public’s priorities among various components of health services Giora Kaplan, etl Gertner Institute Tel Hashomer Israel

  15. Stories • Striking for Avastin • The Deputy Minister and Dental Care • Life Saving Drugs and supplemental/private insurance • HMOs voluntarily initiating programs in health promotion, cultural competence and reduction of health inequalities

  16. Conclusions • The Israeli public has matured regarding priority setting • Exhausting priority setting process raises the “specter” of prevention, reducing inequalities • The public prioritizes prevention and equity more than decision makers think • The public prioritizes dramatic interventions less than decision makers think • Obama should visit Israel for a number of reasons, but in any case good luck….

  17. Implications • Priority setting underpinnings • Forced into corner of tradeoffs • Institutional arrangements that merit trust • Insert public opinion data into the public debate • Ongoing

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