Gross Revital
JDC-Brookdale Institute, JDC Hill, Jerusalem, and Bar-Ilan University, Ramat Gan, P.O. Box 13087, Jerusalem 91130, Israel.
Health Policy. 2004 May;68(2):143-58. doi: 10.1016/j.healthpol.2003.09.005.
Many countries have reformed their health care systems in the past decade and, as such, the need to monitor health system performance is widely recognized. In this paper we present a method for constructing quality indicators, which were used to evaluate the reformed Israeli health care system, and demonstrate the sensitivity of these indicators to change over time and to differences in quality among health plans and among population groups. The quality indicators were developed based on consumers' reports of their experiences in the health system. The indicators were measured in periodic population telephone surveys conducted between August and October of 1995, 1997, and 1999, using a structured questionnaire in Hebrew, Arabic, or Russian, this ensured the inclusion of all major sub-groups of Israel's population. Between 1080 and 1749 people were interviewed, with a response rate of over 80% each year. Using the theory-based evaluation approach, we specified the plausible causal links among intervention (components of the National Health Insurance Law), intermediate outputs (changes in health plan organizational behavior), and consumer outcomes. This led to the identification of indicators of quality of ambulatory health services, which included measures of accessibility, availability, patient satisfaction, performance of preventive medicine, and utilization of private medical services. The consumer-based evaluation tool presented in this paper was found to be easy to apply, sensitive, and relatively inexpensive. We hope that our approach will be of use to other countries that want to evaluate system-wide change and monitor quality of services over time.
在过去十年中，许多国家都对其医疗保健系统进行了改革，因此，监测卫生系统绩效的必要性已得到广泛认可。在本文中，我们提出了一种构建质量指标的方法，该方法用于评估改革后的以色列医疗保健系统，并展示了这些指标对随时间变化以及不同健康计划和人群之间质量差异的敏感性。这些质量指标是根据消费者对其在医疗系统中的经历的报告制定的。这些指标是在1995年、1997年和1999年8月至10月期间进行的定期人口电话调查中测量的，使用希伯来语、阿拉伯语或俄语的结构化问卷，这确保了以色列所有主要亚群体都被纳入。每年采访1080至1749人，回复率超过80%。使用基于理论的评估方法，我们明确了干预措施（《国家健康保险法》的组成部分）、中间产出（健康计划组织行为的变化）和消费者结果之间合理的因果联系。这导致确定了门诊医疗服务质量指标，其中包括可及性、可用性、患者满意度、预防医学绩效以及私人医疗服务利用情况的衡量指标。本文提出的基于消费者的评估工具被发现易于应用、敏感且成本相对较低。我们希望我们的方法对其他想要评估全系统变化并长期监测服务质量的国家有用。
