[The British Star rating system--review and its implication for the Israeli health system].

The British NHS system is undergoing a process of reform and renewal. In addition to allocating resources, the NHS developed the star rating system, a system developed to evaluate and increase performances of the medical institutes. The rating of zero to three stars of the general hospitals (acute trusts) is based on the level of achievements of the 9 key targets and 36 indicators composing 3 focus areas: clinical, patient and logistic aspects. The key targets and performance indicators are determined every year based on the accomplishments of the previous year and actual problems. The 2004 key targets included shortening waiting times in the emergency room and waiting lists for elective admission and ambulatory clinics, hospital finance management and hospital cleanliness. We examined the evaluation system in relation to the goals set, after a three-year period. There is impressive progress in the quality and level of medical care given in the areas examined. Besides the improvement, criticism arose in respect of different aspects: the hospital rating does not necessarily reflect the quality of care given in the individual departments, the publicity of the hospital ratings had a deleterious effect on the patient trust in the medical staff and their relationship, the hospitals requested to be involved in the process of choosing the indicators etc. The method for evaluating hospitals is one of the top issues on the agenda of the leaders of the Israeli health system. It is known that the evaluation process itself leads to improvement but it might also have a harmful effect. The application of the British Star system to the Israeli system requires core adjustments: defining relevant indicators based upon current problems, securing the quality of the data, defining the correct case-mix of patients and working in full cooperation with the hospital managers and the professional authorities. The publicity aspect is a delicate issue considering the current restrictions on patient's freedom of choice.