Evaluation of personal health services as a basis for health planning. A review with applications for Israel.

Health care systems throughout the world are being scrutinized because of their growing cost in relations to national wealth. At the same time, techniques for evaluating health care with respect to appropriateness, quality and resource allocation are being developed. These techniques are multifactorial since they must relate to all aspects of health care including: characteristics of the population being served; available health care resources; measures of the process and utilization of care; measures of health care outcomes; peer review, including quality assessment of health care providers; consumer attitudes, knowledge, and compliance; care provided for "tracer" or sample conditions; and economic cost-benefit studies. Evaluation in health care assumes that a health care system and the providers of health care within that system are responsible and accountable for the health status of the population. It must, however, recognize that health services are not the sole determinants of health status; social, economic and cultural factors also play key roles. A comprehensive approach to evaluation in health care is outlined in this review. Many of the components that are available in the Israeli health care system are described; others that remain to be developed are discussed. Evaluation is an integral part of a comprehensive health care system; the components of evaluation must be built into any national system. As long as rationality is expected of health care, evaluation is an essential element of the overall system.