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Choosing Services within the Public Hospital System

3/07/2017

Researchers : Shuli Brammli-Greenberg, Tamar Medina-Artom and Alexey Belinsky

 

Summary


In the 2016 survey of public opinion on the level of service and performance of the healthcare system, which was designed to evaluate the impact of the National Health Insurance (NHI) Law on a variety of topics in the health system (e.g., level of service and consumer satisfaction), the respondents were also asked about choice within the public hospital system 1,2

 

1  Details about the survey appear at the end of this document.
2  All the differences presented in the document are statistically significant unless stated otherwise.

 


• Most of the respondents (84%) reported that in their opinion, everyone should be given the choice of surgeon in public hospitals (at no extra cost).


• Of those who had had surgery: 64% reported that their health plan had paid for the operation and 36% that it was paid for privately through supplemental insurance, commercial insurance or out-of-pocket.


• Almost all of the respondents (90%) reported that it was important or very important for them to know who would be operating on them; 89% reported thus regarding the choice of surgeon and 79% regarding the choice of hospital. 
 

• Only respondents who had had surgery were asked about the importance of waiting times: 80% noted that it had been important or very important for them to reduce the waiting time for the surgery.

 

• The three factors noted as the most important in choosing a surgeon were: Choosing the best professional for the treatment; personal approach and time spent with the surgeon; recommendations and the reputation of the surgeon. Among respondents who had had surgery, a higher percentage noted the importance of a personal approach and time with the surgeon. 
 

• The three factors noted as the most important in choosing a hospital were: Getting medical treatment of a high standard; personal approach and good attitude of the staff; and good conditions in the hospital.

 

• Among those who had asked for a voucher or referral to the service provider from the health plan in the previous year, 46% reported that they could choose whomever they wanted; 26% reported the health plan gave them a list of service providers to choose from, and 28% noted that they could not choose.

 

Background to Choosing Services within the Public System


The principle guiding the legislators of the NHI Law was to allow patients to choose their health plan, while the health plan would choose the suppliers it works with. The health plans in Israel, like other managed care organizations abroad, are meant to allow choice among the service providers with whom they have an agreement and those employed by them. With regard to the public hospitals, there is not yet a mechanism to allow patients to express their personal preferences, apart from some local initiatives in certain hospitals. Among other things, limiting the option of choosing services within the hospital frameworks makes it easier for various players in the system to attract patients to the private system.

 

Main Findings


Choice of Surgeon in Public Hospitals for Everyone at No Extra Cost


• All the respondents were asked: "In your opinion, should the choice of surgeon in public hospitals be given to everyone at no extra cost?" Most (84%) responded that in their opinion the choice of surgeon in public hospitals should be given to everyone at no extra cost.

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Note that no significant differences were found among population groups, apart from differences by age and income. The percentage of respondents who reported that in their opinion the choice of surgeon in public hospitals should be given to everyone at no extra cost was lower among respondents with higher incomes and among older respondents. However, the differences were small and most of the population of all levels of income and in all age groups believe that this right should be given to everyone at no extra cost (figure 2).
 
 
 
 

 

 




 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Correlation between Importance of Choice and Confidence in the System


• Respondents' level of confidence that they would receive help in the event of a serious illness was low: 44% were confident or very confident that they would get the best and most effective treatment in the event of a serious illness and 31% were confident or very confident that they would be able to afford the treatment they need.


 

• Respondents' level of confidence that they would receive help in the event of a serious illness was even lower among those in whose opinion the choice of surgeon in public hospitals should be given at no extra cost in two measures: Confidence in the ability to afford the treatment: 71% among those who reported that the choice of surgeon should be given at no extra cost, vs. 59% among the others; and confidence that they would get the best and most effective treatment: 58% among those who reported that the choice of surgeon should be given at no extra cost, vs. 46% among the others.

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Having Surgery and who Paid for it


• 14% of the respondents reported that they had had surgery in the previous two

years (3% emergency surgery and 11% elective surgery). Of these: 64% reported that the health plan paid (through Form 17) and 36% reported that the surgery was paid privately through supplemental insurance, commercial insurance, or out of pocket.

• Those who had had surgery were asked what had been important for them when deciding about the surgery. Eighty percent said that ahead of the surgery, it was important or very important for them to reduce the waiting time (65% very important and 15% important).


 

Importance of Parameters Relating to Choice when Surgery is Required


• All the respondents were asked what was important to them when they needed surgery. Ninety percent noted that it was important or very important to them to know who would perform the surgery (74% very important, 16% important); 89% to choose the surgeon (71% very important, 18% important) and 89% to choose the hospital (69% very important and 20% important).

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

• Among those who responded that it was very important to choose the surgeon, 88% noted that in their opinion everyone should be able to choose their surgeon at no extra cost. However, even among those who responded that it was not so important or not important to choose the surgeon, a high percentage noted that in their opinion everyone should be able to choose their surgeon at no extra cost (70%).


Important Factors when Choosing a Surgeon and Hospital


• All the respondents were given a list of factors and asked to indicate those that were the most important when choosing a surgeon. More than one factor was allowed. Forty-eight percent indicated the choice of the best professional for the treatment; 24% noted recommendations and the surgeon's reputation; 17% noted a personal approach and time with the surgeon.

 

• Among those who had had surgery, a higher percentage noted the importance of a personal approach and time spent with the surgeon.


 

• All the respondents were asked to indicate the most important factors when choosing a hospital. In this case, a greater range of important factors was recorded: 28% of the responses noted medical treatment of the highest professional standard; 23% personal approach and good attitude of the staff; and 16% good conditions in the hospital. Other factors noted: reputation of the hospital, proximity to home, and waiting time.

 

Ability to Choose Service Provider when Issued with a Voucher from the Health Plan


 

• In the previous year, 54% of the population asked the health plan for a voucher for a service provider: 14% for hospitalization; 24% for outpatients; 27% for a specialist; 27% for a diagnostic institute; and 8% for other services.


 

• Among those who requested vouchers, 46% reported that they could choose the provider; 26% that they chose from a list of service providers given by the health plan; and 28% said they were not given a choice (the health plan told them where to go).


 

o Among those who requested a voucher for hospitalization in the previous year: 58% noted that they could choose wherever they wanted; 16% chose from a list; and 26% had no choice.


 

o Among those who requested a voucher for outpatients in the previous year: 48% noted that they could choose wherever they wanted; 19% chose from a list; and 33% had no choice.


About the Survey


Since 1995, the Myers-JDC-Brookdale Institute has been monitoring the healthcare system from the perspective of the consumers. The latest survey was conducted from August to December 2016 under the direction of Dr. Shuli Brammli-Greenberg, Tamar Medina-Artom and Alexey Belinsky, with the support of a steering committee comprising representatives of all the health plans, the Ministry of Health, the Ministry of Finance, the National Insurance Institute (NII) and consumer organizations.

 

The data are collected at MJB by the Institute's Data Collection Unit headed by Chen Tzuk-Tamir and coordinator by Lev Zhivaev, under the supervision of the research team. The sample is a representative sample of the adult population (age 22+) in Israel. This year it also included respondents who owned cellphones only (i.e., no landline). Altogether, 2,513 individuals were interviewed in three languages (Hebrew, Arabic, and Russian) and there was a 68% response rate. The characteristics of the sample are close to those of the population according to data from the Central Bureau of Statistics, the Ministry of Health and the NII. The data were weighted by age for accurate representation of the various age cohorts. A full summary of the study findings in Hebrew can be found on our website:
http://brookdaleheb.jdc.org.il/_Uploads/dbsAttachedFiles/Summary(1).pdf ;
The methodology appendix also appears on our website (in Hebrew):
http://brookdaleheb.jdc.org.il/?CategoryID=199

 

For citations :


Brammli-Greenberg, S.; Medina-Artom, T. and Belinsky, A. 2017. Summary of Findings from the Eleventh Survey of Public Opinion on the Level of Service and Performance of the Health Care System. Myers-JDC-Brookdale Institute: Jerusalem (Hebrew).

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Correlation between Importance of Choice and Confidence in the System


• Respondents' level of confidence that they would receive help in the event of a serious illness was low: 44% were confident or very confident that they would get the best and most effective treatment in the event of a serious illness and 31% were confident or very confident that they would be able to afford the treatment they need.
• Respondents' level of confidence that they would receive help in the event of a serious illness was even lower among those in whose opinion the choice of surgeon in public hospitals should be given at no extra cost in two measures: Confidence in the ability to afford the treatment: 71% among those who reported that the choice of surgeon should be given at no extra cost, vs. 59% among the others; and confidence that they would get the best and most effective treatment: 58% among those who reported that the choice of surgeon should be given at no extra cost, vs. 46% among the others.

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Having Surgery and who Paid for it


• 14% of the respondents reported that they had had surgery in the previous two

years (3% emergency surgery and 11% elective surgery). Of these: 64% reported that the health plan paid (through Form 17) and 36% reported that the surgery was paid privately through supplemental insurance, commercial insurance, or out of pocket.
• Those who had had surgery were asked what had been important for them when deciding about the surgery. Eighty percent said that ahead of the surgery, it was important or very important for them to reduce the waiting time (65% very important and 15% important).


 

Importance of Parameters Relating to Choice when Surgery is Required


• All the respondents were asked what was important to them when they needed surgery. Ninety percent noted that it was important or very important to them to know who would perform the surgery (74% very important, 16% important); 89% to choose the surgeon (71% very important, 18% important) and 89% to choose the hospital (69% very important and 20% important).

• All the respondents were asked what was important to them when they needed surgery. Ninety percent noted that it was important or very important to them to know who would perform the surgery (74% very important, 16% important); 89% to choose the surgeon (71% very important, 18% important) and 89% to choose the hospital (69% very important and 20% important).

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


• Among those who responded that it was very important to choose the surgeon, 88% noted that in their opinion everyone should be able to choose their surgeon at no extra cost. However, even among those who responded that it was not so important or not important to choose the surgeon, a high percentage noted that in their opinion everyone should be able to choose their surgeon at no extra cost (70%).


Important Factors when Choosing a Surgeon and Hospital


• All the respondents were given a list of factors and asked to indicate those that were the most important when choosing a surgeon. More than one factor was allowed. Forty-eight percent indicated the choice of the best professional for the treatment; 24% noted recommendations and the surgeon's reputation; 17% noted a personal approach and time with the surgeon.
• Among those who had had surgery, a higher percentage noted the importance of a personal approach and time spent with the surgeon.
• All the respondents were asked to indicate the most important factors when choosing a hospital. In this case, a greater range of important factors was recorded: 28% of the responses noted medical treatment of the highest professional standard; 23% personal approach and good attitude of the staff; and 16% good conditions in the hospital. Other factors noted: reputation of the hospital, proximity to home, and waiting time.

 

Ability to Choose Service Provider when Issued with a Voucher from the Health Plan

• In the previous year, 54% of the population asked the health plan for a voucher for a service provider: 14% for hospitalization; 24% for outpatients; 27% for a specialist; 27% for a diagnostic institute; and 8% for other services.
• Among those who requested vouchers, 46% reported that they could choose the provider; 26% that they chose from a list of service providers given by the health plan; and 28% said they were not given a choice (the health plan told them where to go).
o Among those who requested a voucher for hospitalization in the previous year: 58% noted that they could choose wherever they wanted; 16% chose from a list; and 26% had no choice.
o Among those who requested a voucher for outpatients in the previous year: 48% noted that they could choose wherever they wanted; 19% chose from a list; and 33% had no choice.


About the Survey


Since 1995, the Myers-JDC-Brookdale Institute has been monitoring the health care system from the perspective of the consumers. The latest survey was conducted from August to December 2016 under the direction of Dr. Shuli Brammli-Greenberg, Tamar Medina-Artom and Alexey Belinsky, with the support of a steering committee comprising representatives of all the health plans, the Ministry of Health, the Ministry of Finance, the National Insurance Institute (NII) and consumer organizations.

 

The data are collected at MJB by the Institute's Data Collection Unit headed by Chen Tzuk-Tamir and coordinated by Lev Zhivaev, under the supervision of the research team. The sample is a representative sample of the adult population (age 22+) in Israel. This year it also included respondents who owned cellphones only (i.e., no landline). Altogether, 2,513 individuals were interviewed in three languages (Hebrew, Arabic, and Russian) and there was a 68% response rate. The characteristics of the sample are close to those of the population according to data from the Central Bureau of Statistics, the Ministry of Health and the NII. The data were weighted by age for accurate representation of the various age cohorts. A full summary of the study findings in Hebrew can be found on our website:
http://brookdaleheb.jdc.org.il/_Uploads/dbsAttachedFiles/Summary(1).pdf ;
The methodology appendix also appears on our website (in Hebrew):
http://brookdaleheb.jdc.org.il/?CategoryID=199http://brookdaleheb.jdc.org.il/?CategoryID=199 .

http://brookdaleheb.jdc.org.il/_Uploads/dbsAttachedFiles/Summary(1).pdf ;
The methodology appendix also appears on our website (in Hebrew):
http://brookdaleheb.jdc.org.il/?CategoryID=199http://brookdaleheb.jdc.org.il/?CategoryID=199 .

 

For citations :


Brammli-Greenberg, S.; Medina-Artom, T. and Belinsky, A. 2017. Summary of Findings from the Eleventh Survey of Public Opinion on the Level of Service and Performance of the Health Care System. Myers-JDC-Brookdale Institute: Jerusalem (Hebrew).

 

 

 

 

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