Healthy Israel 2020: National Health Targets

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

Israel has embarked on a major new initiative, "Healthy Israel 2020", which will set national health targets with strategies for achieving them for the year 2020. Over 250 leaders in the health system have been mobilized and organized into 21 working groups among them: health behaviours, environment, youth, healthy aging, legislation. Each group has been charged with using epidemiological evidence to determine key health objectives, set quantitative targets, and strategies for achieving them.

Purpose of health policy or idea

The process seeks to increase the extent to which health system planning efforts (and subsequent resource allocations) focus on health achievement, health promotion and disease prevention, as compared with the traditional focus on curative services and other health care inputs.

Characteristics: Over 250 leaders in the health system have been mobilized and organized into 21 working groups which include health behaviours, environment, youth, healthy aging, knowledge base, legislation, and communication. Each group has been charged with using epidemiological evidence to determine key health objectives, set associated quantitative targets, and lay out strategies for achieving them.

Data and evidence are to play a major role, both in choosing objectives, in setting targets, and in prioritizing intervention strategies. A professional staff has been assembled to manage the entire process, under the guidance of top Ministry of Health executives.

Main points

Main objectives

Establish health goals and strategies for achieving them for the nation for the year 2020. This will be done on the basis of burden of disease and the feasibility of implementing strategies for change.

Type of incentives

To be determined on the basis of successful incentive  schemes used locally and internationally.

Interested in encouraging high-level clinical preventive performance as well as positive and negative incentives in the non-clinical sphere.

Aspires to enact legislation to encourage such incentives.

Groups affected

The entire population of the State of Israel,, Special emphasis on populations with lower health status and/or higher risk

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

The main element of innovation in this process is its evidence-based nature, where evidence includes a combination of burden of disease data and evidence for effectiveness of interventions.

Controversial issues will be decided by consensus within each of the working groups, with guidance from project staff. It has the potential for significant impact if implemented. Within the health system, this may depend largely on incentivizing at the level of the physician or sick fund.

There has already been some visibility through media coverage of conferences, and this will be expanded with an opportunity for the public to respond via email to draft documents on our website.

Transferability to other countries is dependent on similarities between health care systems, burden of disease, and social norms regarding  participation of the civilian population in health planning.

Political and economic background

The initiation of the process stems from two sources:

1. Israel's commitment, as a member of the WHO region, to develop a Health for All program;
2. The interest of the Ministry of Health leadership in increasing the attention given to the health of the population, health promotion and disease prevention.

Change based on an overall national health policy statement

Israel's commitment, as a member of the WHO region, to develop a Health for All program

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

"Healthy Israel 2020" is an update of previous targeting experience in 1989 in Israel, and as such will draw lessons from that experience. One of the primary lessons of the early targeting efforts was that the process was constrained by the limited amount of epidemiological data on population health. The effort led to considerable investment of resources into national representative surveys, so that today the knowledge base about health is much improved.  Awareness of the potential contribution of health promotion and disease prevention was much less widespread than it is now, and the knowledge base of successful intervention strategies abroad was less sophisticated.

In addition, this process will draw on the experience of the U.S. with Healthy People  and on the experience in Europe with Health for All (Health 21).

Initiators of idea/main actors

• Regierung

• Leistungserbringer

Approach of idea

The approach of the idea is described as:
renewed: National Health Targets 2000, Prepared in 1989

Stakeholder positions

There are no groups who have come out against the development of a national health plan. The main potential obstacles are insufficient resources and inadequate commitment, rather than outright opposition. This process attempts to form a coalition based on working groups, whose leaders and members come from various sectors, including sick funds, academicians, and government employees. Players in the upper echelons of the Ministry of Health initiated the process, and sick fund directors were given jurisdiction over appointments from their organizations. The public will be given a period to respond to an initial draft of the report.

Actors and positions

Regierung
Ministry of health	sehr unterstützend		stark dagegen
Ministry of Finance	sehr unterstützend		stark dagegen
Ministry of Enviornment	sehr unterstützend		stark dagegen
Leistungserbringer
Sick funds	sehr unterstützend		stark dagegen

Influences in policy making and legislation

The planned blueprint, which will include specific targets and strategies for achieving them, will be brought to the Knesset for formal governmental approval upon completion.

Actors and influence

Regierung
Ministry of health	sehr groß		kein
Ministry of Finance	sehr groß		kein
Ministry of Enviornment	sehr groß		kein
Leistungserbringer
Sick funds	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

Once formally ratified by the government, the blueprint will be disseminated to all health system and related players in order to prioritize health-related actions. At present there is no specific governmental commitment to implementation.

Monitoring and evaluation

The project staff has recommended monitoring of process and outcomes, with re-evaluation of stated targets at regular intervals. Appropriate monitoring strategies will be determined by committee members in coordination with project staff. However, at present, there is no governmental commitment to either monitoring or regular re-specification of targets. 

Expected outcome

Because this is a Ministry-of-Health initiated endeavor, this project has enormous potential for public health improvement, through its focus on disease prevention and health promotion. Its actual impact will depend largely on the strength of the political will to implement its recommendations.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

The quality of clinical preventive services will improve dramatically if implementation ensues. The working group on equity will strive to find ways to make distribution of resources more equitable; implementation will depend on available resources and political will. Cost effectiveness could improve dramatically if the recommendations take cost into account and if they are implemented.

These outcomes depend primarily on the extent to governmental commitment to implementation. If implemented, even in part, there could be a significant effect on population health.

References

Sources of Information

• Healthy People 2010: www.healthypeople.gov/
• Health for All: HEALTH21: an introduction to the health for all policy framework for the WHO European Region. www.euro.who.int/InformationSources/Publications/Catalogue/20010911_39
• Rosenberg E, Clarfield AM, Rasooly I, and the National Geriatrics Council Committee for Health Promotion and Disease Prevention in Older Adults. A Framework for Evidence-Based Geriatric Prevention in Israel. IMAJ 2003: 5: May: 379-382.
• Report of Israel Ministry of Health National Geriatric Council health promotion & disease prevention in elders. www.health.gov.il/pages/default.asp?maincat=40

Author/s and/or contributors to this survey

Laura Rosen, Elliot Rosenberg and Bruce Rosen

Empfohlene Zitierweise für diesen Online-Artikel:

Laura Rosen, Elliot Rosenberg and Bruce Rosen. "Healthy Israel 2020: National Health Targets". Health Policy Monitor, May 2006. Available at http://www.hpm.org/survey/is/a7/1