Green Ilan, Huerta Michael, Bar-Dayan Yosefa, Fire Gil
Health Service and Equipment Center, IDF.
Harefuah. 2009 Apr;148(4):243-7, 276.
Increasing global expenditures on health, together with increased patient demand for quality and service, have created a need for health care management tools based on economic and quaLity-based criteria. Despite the recognition of this need, decision-support tools are Lacking. In the Israel Defense Forces (IDF), policy change and budgetary and quality constraints necessitated the development of an evidence-based managerial decision aid, to assist in providing medical services at acceptable quality and availability leveLs, while addressing economic concerns.
To develop a decision-support model for the IDF Medical Corps, that balances the conflicting considerations of service avaiLabiLity and cost.
The authors developed a manageriaL model to characterize regional secondary medical care, and to compare it to country-wide patterns and to historic regional patterns. Secondary care systems were then analyzed by specialty. Finally, the relative costs of medical encounters for each speciaLty were anaLyzed.
Core specialties examined included dermatology, orthopedics and otolaryngology. Two-thirds of all referrals to core specialists were made to intra-organizational resources. Furthermore, several intra-organizationaL clinics were found to have short waiting times and low output indices. In response to the application of the model, IDF Medical Corps policy was updated and suppliers were reprioritized, yielding substantial savings of up to NIS 5.5 million in 2006 alone. This cost saving enabled budgetary reallocation and alternative investment in the emergency and primary health care systems.
Applying efficient managerial tools can lead to cost savings and to increased quality and availability of services. These tools must effectively follow changes in the dynamics of the health care system. These changes are to be impLemented rapidly, in order to provide practical guidance for medical administrators and to enable them to infLuence the real-time utiLization of medical services.
全球卫生支出不断增加，同时患者对医疗质量和服务的需求也在上升，这就需要基于经济和质量标准的医疗管理工具。尽管人们认识到了这种需求，但决策支持工具却很匮乏。在以色列国防军（IDF）中，政策变化以及预算和质量限制使得有必要开发一种基于证据的管理决策辅助工具，以协助在可接受的质量和可及性水平上提供医疗服务，同时解决经济问题。
为以色列国防军医疗队开发一种决策支持模型，以平衡服务可及性和成本这两个相互冲突的考量因素。
作者开发了一种管理模型，以描述区域二级医疗保健情况，并将其与全国模式以及历史区域模式进行比较。然后按专科对二级医疗保健系统进行分析。最后，分析每个专科医疗就诊的相对成本。
所研究的核心专科包括皮肤科、骨科和耳鼻喉科。所有转诊至核心专科医生的病例中有三分之二是转诊至组织内部资源。此外，发现几个组织内部诊所的等待时间短且产出指标低。根据该模型的应用结果，以色列国防军医疗队的政策得到更新，供应商的优先级也重新确定，仅在2006年就节省了高达550万新谢克尔的大量资金。这些成本节省使得能够重新分配预算，并对急诊和初级卫生保健系统进行替代性投资。
应用高效的管理工具可以节省成本，并提高服务质量和可及性。这些工具必须有效地跟踪医疗保健系统动态的变化。这些变化应迅速实施，以便为医疗管理人员提供实际指导，并使他们能够影响医疗服务的实时利用情况。
