Data and Decision Making in the NHI Era: A Summary Report

The Myers-JDC-Brookdale Institute has conducted a multiyear study of the role that data and research have played in key governmental decisions related to the implementation of the National Health Insurance (NHI) Law. The study sought to pinpoint where data have contributed to decision making, where they have not, and why. It was based on in-depth interviews with policymakers, managers and researchers, and a review of relevant documents.

The study had five major components. It began with a comparative analysis of the use of data in 10 top-level NHI-related policy decisions. Next, in-depth case studies were carried out regarding the use of data in two key health policy processes: the mental health reform and the work of the Public Commission on the Publicly Financed Health Care System and the Status of Physicians (the Amorai Commission). Finally, two other case studies examined the uses of important data sources: the Central Bureau of Statistics health survey and the health plan financial reports (the Witkowsky Report). Detailed findings from each of the five components have been published in separate Institute reports; this summary report brings together the key findings in an integrated fashion.

The study found that:

  • Data and research contributed greatly to policy development in 1995-1999 and data use increased over time.
  • Decision-makers throughout the health system make extensive use of data.
  • Nonetheless, policymakers often had to make decisions in the absence of important information.
  • In many instances, policymakers were inundated with data but were still missing those specific pieces of data they needed most in order to make informed decisions.
  • Data sources that were designed in response to policymakers’ concrete information needs contributed the most to the policy development process.
  • The health system could benefit greatly from relatively modest investments in a few key national data systems.
  • Policymakers rarely engaged in structured analyses of the decisions they faced and the ways in which data could contribute to those decisions. They also indicated that the kind of structured analysis employed in this study can and should be done at an early stage of the policymaking process.

The findings suggest that if policymakers are to have more of the key data, they will need more analytic staff persons, more targeted research and data generation activities, more advanced planning, more and better forecasts, and the formation of a few pivotal national databases.

The findings have been widely disseminated, and it appears that the findings have already encouraged Israeli researchers and policymakers to think more systematically and proactively about the links between data and policymaking.

This project was funded by the Connie and Bert Rabinowitz Fund for Creative Breakthrough Research at the JDC-Brookdale Institute and by a grant from the Israel National Institute for Health Policy and Health Services Research.