Monitoring Quality in Israeli Primary Care: The Perspective of the Frontline Physician

Israel has a well-developed system for monitoring the quality of the community-based health services delivered through its four competing health plans. The system encompasses over 40 indicators, with a focus on immunization, screening for breast and colon cancer, diabetes care, asthma and cardiovascular care. Previous Institute studies have found that this monitoring system has led the health plans to undertake a wide range of quality improvement measures and that performance on the quality measures has improved rapidly – in fact, far more rapidly than  in the US, whose monitoring system served as the model for the Israeli system.

This study extends that line of research by examining how front-line physicians perceive the program and how it has affected their practices. It is based on a survey of a nationally representative sample of over 600 primary care physicians that was carried out in 2010. The study was overseen by a steering committee comprising representatives of the Ministry of Health, the Israel National Institute for Health Policy Research, the National Program for Quality Indicators in Community Healthcare, the health plans and the Association of Family Physicians in Israel.

The study explores the physicians’ perspectives on such issues as:

  • Has the monitoring system helped them become better clinicians?
  • What specific changes have they made in their practices to improve quality?
  • How has the quality monitoring effort affected their workload?
  • What changes should be made in the monitoring system and its use by the health plans?

The study findings are expected to help Israeli health system leaders refine the quality monitoring system and make it more responsive to the needs and concerns of front-line physicians. In addition, the study has international significance, as despite the recent proliferation of quality monitoring systems around the world, this is one of the first large-scale studies to examine how these systems are experienced by front-line physicians. The study has been presented at several national conferences and in a variety of health-plan forums. It has generated an in-depth discussion of the findings and their implications for the efforts to improve quality.

The study was commissioned and funded by the Israel National Institute for Health Policy and Health Services Research.