Information and Decisionmaking – Public Commission on the Publicly Financed Health Care System and the Status of Physicians (Amorai Commission): Analysis of a Case Study

This report is a case study analyzing the use of data in the work of the Public Commission on the Publicly Financed Health Care System and the Status of Physicians (known popularly as the “Amorai Commission”). The Amorai Commission was established at the conclusion of a four-month strike by physicians in 2000 as part of the agreement between employers and the Israel Medical Association, and addressed major issues in the health care system.

This report was prepared in the framework of a multi-year study by the Myers-JDC-Brookdale Institute on the role of data in decisionmaking in the health care system. Examining the Amorai Commission’s work and the way in which it used information provided an opportunity for an in-depth examination of one of most important venues through which data can influence decisionmaking in the health care system – public commissions. To this end we examined the following:

  • The patterns of information use in the Amorai Commission’s work
  • The characteristics of the Commission’s work that had an impact on its use of information
  • Which information was lacking in the main issues addressed by the Commission
  • What can be learned from this case study regarding the utilization of information in the health care system and in the work of public commissions.

The study found that the Amorai Commission sought to develop proposals that would be acceptable to all the key actors in the health system (i.e., the government, the medical association, and the major providers). Furthermore, it decided that it would address a wide range of health policy issues (i.e., broader than its original mandate) and that it would formulate general recommendations only, without going into detail.

The Commission made a strategic decision to maintain a small staff and rely heavily on the interested parties for information and analysis. These parties invested significant time and energy in preparing data-rich submissions to the Commission. The Commission made substantial use of the data presented to it, but the lack of staff impeded the integration of data from these and other sources. In the end, the Commission developed its recommendations in the absence of critical data on key issues, such as physician incomes, the public-private mix, and the levels of efficiency and quality in the health care system.

The study suggests that public commissions can learn a great deal by encouraging the interested parties to make serious presentations, but at the same time there is a need for adequate staff work in order to best mobilize the available data, resolve contradictions in the data provided by various groups, and provide analyses of the data.

This study was supported by the Connie and Bert Rabinowitz Fund for Creative Breakthrough Research at the Myers-JDC-Brookdale Institute, and by a grant from the National Institute for Health Policy and Health Services Research.