Israel Journal of Health Policy Research最新文献

Background: Housing is a fundamental condition for health and wellbeing. Housing situation- including affordability, stability, and quality- has been associated with a wide range of health outcomes. Israel is home to a decades-long housing crisis, with housing stock unable to meet demand, lacking housing quality regulation, and few protections for renters.

Main body: This paper presents a review of evidence on housing and health and an overview of the housing situation in Israel. Using a health in all policies framework, we present examples of how public health researchers are leading interdisciplinary research to strengthen the evidence base to change housing policies.

Conclusion: Ultimately, this paper serves as a call to Israeli researchers in the health sciences, urban studies, architecture, public policy, and other relevant fields to take interest in building a local evidence base and promote healthy housing models.

Background: Dietary guidelines for families with children are designed to meet the Dietary Recommended Intake. However, the cost of a healthy diet and the extent to which families can afford it in Israel is unclear.

Methods: The age distribution and the number of children per household by income quintile and geographic area in Israel in 2018 were obtained from the Central Bureau of Statistics. Food cost information was purchased from the commercial company Stornext. The cost of the recommended food items in the healthy diet for adults and children (by age group) was calculated using standard food portions and meal frequency and expressed as a percentage of the households net income. The proportion of households for which food expenditures exceeded 15% of the net income was calculated, followed by changes in food prices during 2018.

Results: The average daily cost of a healthy diet for an average Israeli family was 35.5 ± 7.7 New Israeli shekels (equivalent to $9.7 ± $2.11). For households with children, the median monthly cost of the recommended diet, as a percentage of net household income was 20%. There was an inverse association with socioeconomic status, as the median monthly food expenses for the first (lowest) quintile were 55% of the household's net income and only 9.3% of the 5th (highest) income quintile. By geographic residential area, the median percentage of the net income from monthly dietary costs was 23%. The highest costs were in Judea, Samaria, and Jerusalem. Lunch made up 47% of food expenditures, if theoretically omitted, diet expenditures for households with children would decrease by an average of 15%. The food group that composed the highest component of the food budget was the vegetable group, with an average cost of 29% monthly, followed by the meat and meat substitutes group (19%).

Conclusion: This theoretical calculation shows that two-thirds of the households with children in Israel could not purchase the recommended diet in 2018, with significant disparities according to socioeconomic status. Policymakers should consider steps to decrease health inequality in food affordability, targeting the three middle-lower income quintiles. Our findings suggest the need to expand the provision of school lunches. Further research is required to examine how changes in household food costs influence consumers' food choices and the potential health implications of the high expenses identified in this study.

Background: Wait times (WTs) for Magnetic Resonance Imaging (MRI) are rising in many countries. Long WT delay diagnosis and treatment, and affect patient satisfaction. Little research has examined the patient experience of scheduling and waiting for an MRI. This study aimed to assess difficulty of scheduling an appointment for MRI from patients' perspectives; and to identify factors associated with longer WT and greater difficulty.

Methods: An online survey of patients' experience of scheduling an MRI was conducted in January-February 2023 among a representative sample of 557 Israeli adults. All participants had undergone an MRI in the public health system within the past year.

Results: Median WT was 1-2 months and did not differ significantly by demographic variables or exam type. 28% considered the WT unreasonable. WTs ≥ 1 month were reported by two thirds of respondents; longer WT were reported for respondents who tried to get an earlier appointment compared to those who did not (p < 0.001). WT for radiology report was significantly related to shift (shorter WT for morning MRI exams, p = 0.045), sex (men reported shorter WT, p = 0.042) and age (over 55s reported shortest WT, p = 0.006). In a stepwise logistic regression modeling the probability of finding the process difficult, significant factors included time between referral and calling to schedule, tried multiple sites, tried to get an earlier appointment, WT for report, and overall reasonableness of WT.

Conclusions: Many patients experienced some difficulty scheduling an MRI, particularly when calling multiple sites, since there is no centralized point of contact. HMO agreements can also lengthen the wait. Alongside objective metrics documented by service providers, it is important to consider patients' perspectives in scheduling imaging. While efforts have been made in recent years to tackle MRI WT, adding scanners and personnel, the majority of patients wait at least a month, and the process of scheduling and waiting for an appointment can be challenging. Policy changes, including greater transparency of WTs in different institutions, and a centralized booking center for MRI, could be considered to streamline the appointment process and reduce the challenges patients face.

Background: The 77th World Health Assembly in May 2024 agreed on several key amendments to the International Health Regulations (IHR) (2005), which are set to enhance global public health preparedness and response mechanisms. These amendments are part of a broader effort to integrate the lessons learned from the COVID-19 pandemic, seeking to create a more globally interconnected and rapid global response mechanism for future health crises, including a new Pandemic Agreement.

Main body: Globally and in Israel, some voice their concern that the IHR amendments and the Pandemic Agreement could undermine a nation's sovereign right to manage its public health response, infringe on national autonomy, or impose obligations such as sharing resources like diagnostics, medicines, technology, or vaccines, which could be seen as detrimental to national interests. This manuscript describes the IHR amendments and the ongoing work on the Pandemic Agreement. It explains how the documents do not undermine national sovereignty and highlights the moral and utilitarian justifications for Israeli support of these global legal documents. From a moral perspective, Israel should be committed to promoting the value of global public health and universal health coverage at both the international and regional levels. From a utilitarian perspective, provisions ensuring access to products and information will assist Israel in preparing for and protecting against health threats originating in neighboring countries and globally. Moreover, asking countries to be better ready may promote awareness and actions of public health services in Israel, which has long suffered from budgetary and health workforce constraints.

Conclusion: Israel must work to promote the endorsement of the Pandemic Agreement and the IHR amendments, as they are essential documents for addressing public health threats without compromising national sovereignty.

Background: Health insurers and managed care organizations often limit patient choice to in-network care providers through selective contracting, involving procurement agreements with service providers or ownership of healthcare institutions. Patient choice reforms, i.e., reforms which expand hospital choice and reduce the power of the selective contracting, were introduced in a number of countries since the 1990s, in order to address long waiting times and enhance hospital competition based on quality, services, and availability. This study was motivated by Israel's 2023 health reform, which expanded patient choice by mandating broader hospital choice and enhancing transparency. This study examines reforms in selective contracting models in developed countries and assesses their impact on healthcare quality, accessibility, and socioeconomic disparities.

Methods: A search was conducted on PubMed, Google Scholar, OECD Library, and European Observatory using keywords related to healthcare reform, provider choice, and selective contracting. The search was limited to English-language articles published since 2001.

Results: Traditionally, NHS-based countries did not include patient choice in their systems. Reforms in countries like England and Portugal have since allowed patients choice between hospitals. In contrast, systems with multiple competing insurers, such as Germany, Switzerland, the Netherlands, and Israel, inherently incorporate some patient choice. Israel's 2023 health reform further broadened hospital choice, while maintaing selective contracting, and enhanced transparency. Patient choice is influenced by distance, quality, and availability. Patients often prefer nearby hospitals but will travel for higher quality care. Increased hospital competition generally improves care quality but may exacerbate socioeconomic disparities. Successful components of patient choice reforms include publishing comparative quality indicators and establishing national appointment scheduling systems. These initiatives increase transparency, improve patient decision-making, and drive hospital improvements.

Conclusions: Expanding patient choice in healthcare enhances system efficacy and patient empowerment. However, addressing socioeconomic disparities is essential to ensure equitable access to high-quality care. Future policies should focus on tools and strategies that cater to all patient groups, including accessible and easily understood comprehensive quality assessments and national appointment scheduling systems. Further research should cover a wider range of healthcare systems to understand the challenges and opportunities in patient choice reforms comprehensively.

Background: Research is the basis of advancement in health and wellbeing in modern societies. Our study aims to examine the funding policy of the Israel National Institute for Health Policy Research (NIHP), a national foundation responsible for assessing the impact of the national Health Insurance Law on health services in Israel. The study aims to evaluate the studies funded from 2010 to 2020, considering their publication in scientific literature and other channels that may influence decision-makers. We compare findings to a previous internal examination of studies funded by the NIHP during 1996-2014. Our paper presents an approach for measuring the impact of health policy research.

Methods: All 378 studies funded by NIHP during the specified years were identified. Objective data were gathered by investigating scientific literature across three datasets: Web of Science (WOS), PubMed, and Google Scholar, including journal impact factor, quarterly index, and citation metrics. Concurrently, a questionnaire was developed to collect additional and subjective data from principal investigators of the funded research projects.

Results: In the final sample of 364 studies funded by NIHP from 2010 to 2020, after 11 were cancelled, and 3 were duplicates. 436 publications were retrieved in peer-reviewed journals. The average time elapsed from funding to scientific publication was 4.65 years. Metric parameters for the top publications of 231 funded studies with at least one publication in peer-reviewed journals revealed an average journal impact factor of 5.97 points and an average of 7.82 citations according to WOS and 14 citations according to Google Scholar. A comparison to 459 funded studies from 1996 to 2014 found a twofold increase in the impact factor. Nearly half of the principal investigators reported some influence on policy processes in the questionnaires, and the majority of the studies were also reported in popular media outlets.

Conclusions: The study provides an overview of the quality and potential influence of studies funded by NIHP, dedicated to supporting research in the field of health policy in Israel. Some of the findings are supported by results from similar inquiries. Several recommendations are introduced to enhance the quality and impact of the funded studies.

There are differences in the rates of short stature (WHO height-z score < -2SD) between the various sectors in Israeli children aged 6-7 years, with higher rates in the ultraorthodox Jewish population. We aimed to: (a) Compare the anthropometric data at 0-2 years of age and the obstetric and demographic data of children with short stature at 6-7 years of age with those of children with normal height. (b) Assess risk factors for short stature at the age of 6-7 years. (c) Evaluate the impact of clinical and socioeconomic factors on linear growth from birth to the age of 6-7 years. This was a retrospective cohort study. Anonymized anthropometric data measured at the first grade of school during 2015-2019 were collected from the Ministry of Health records. The participants were stratified into sectors according to the affiliation of their school. Retrospective growth and sociodemographic data were extracted for each child from the national birth registry and Maternal Child Health Clinics files. The cohort included 368,088 children, with a median age of 6.7 years (IQR 6.3,7.0). Short stature was more prevalent in ultraorthodox Jewish boys (3.8%) and girls (3.2%), and least prevalent in Arab boys (0.8%) and girls (0.7%) compared with all other sectors (P < 0.001). The rate of stunting in Bedouin children was similar to that in the general population (1.6%). In a logistic regression model, the variables that predicted short stature at the age of 6-7 years were female sex, longer gestation, lower height z-score at 2 months of age, birth weight < 90th percentile, being in the ultraorthodox Jewish sector, and a smaller change in height z-score until 2 years of age. Growth gaps between different sectors of school-aged Israeli children emerge during the first 2 years of life. The most vulnerable population for stunting is the ultraorthodox population. Public health services, including Maternal Child Health clinics and primary caregivers, should prioritize this group and closely monitor for growth faltering during the first and second years of life.

Background: Recently, there has been a growing trend of incorporating technology using health applications by official organizations such as health organizations and governmental bodies. In response to the COVID-19 pandemic, Israel implemented a health application to be voluntarily downloaded by citizens (VA). Additionally, the Israeli authorities used mandatory mobile tracking to monitor citizens' movements (GT). The current study aims to identify the factors associated with individuals' decisions to download the voluntary contact-tracing app. We hypothesized that (a) attitudes toward GT will mediate the relations between trust in the healthcare system and downloading VA, and (b) attitudes toward GT will mediate the relations between the perceived COVID-19 threat and downloading VA.

Methods: Data were collected among 741 respondents who completed an online survey on July 19-21, 2020. The survey was designed to represent the diversity of the Israeli population. A logistic regression was calculated with downloading VA as the dependent variable and trust in the healthcare system, perceived threat and attitudes toward GT as independent variables. Then, the extent to which attitudes toward GT mediated the associations between trust in the healthcare system and downloading VA and between the perceived threat and downloading the voluntary app was assessed using the Process procedure.

Results: The findings reveal that 47.1% of respondents perceive governmental tracing as an invasion of privacy, while 24.4% report that it increased their sense of security. About a third report having downloaded the voluntary app. Both research hypotheses were supported; attitudes played a mediating role in the relationship between an individual's level of trust and an individual's level of perceived threat and behavior, i.e., higher trust and higher perceived COVID-19 threat were associated with more favorable attitudes towards GT, which was associated with more substantial odds of downloading VA.

Conclusions: The results emphasize the crucial importance of public trust. Building trust with the public is essential to encourage voluntary actions that ultimately benefit public health. Achieving and maintaining the public's trust requires addressing concerns about the potential misuse of government power and fostering an environment that promotes voluntary participation and engagement.