The Use of Data in the Effort to Transfer Mental Health Services in Israel from the Ministry of Health to the Health Plans A Case Study: 1995-1996

This report is a case study of the use of information in the decisions whether and how to transfer responsibility for mental health services from the Ministry of Health to the health plans. It is part of a multi-year study of the role of information in decisionmaking on key issues related to National Health Insurance. The study highlights the activities that took place in 1995-1996, when the transfer to the health plans was the subject of intense negotiations among the health plans, the Ministry of Health, and the Ministry of Finance, which ended in an impasse.

The policy decision whether or not to transfer mental health services was found to be dependent upon the resolution of nine key sub-decisions. Each of these sub-decisions was analyzed with regard to the information that could have contributed to effective decisionmaking; available and missing information at the time the decision was made; and the role played by data and information in the deliberations.

The study found that there was substantial use of data in decisionmaking at all levels in the mental health system. Data were found to play a significant role in deliberations regarding five of nine sub-decisions. At the same time, the lack of systematic efforts to produce data regarding the likely effect of the transfer on demand for outpatient mental health services – a key unknown – was perhaps one of the main factors that contributed to the ultimate impasse in negotiations.

The study also explores the nature of the “data discourse” (the ways in which data were communicated among organizations) among those involved in decisionmaking. An effective data discourse, involving constructive information sharing and a collaborative effort to distinguish between disagreements about facts and disagreements about values, can promote trust and collaboration. In contrast, the data discourse was found in this case to have been problematic; as a result, it promoted mistrust and mutual allegations. Several alternative explanations for this phenomenon are considered.

This study illustrates the importance of a thorough and structured analysis of the decisions at hand and the data needed to make them on an informed basis. Such an analysis is crucial for helping to understand past decisions, and can be an important aid for structuring future decisions.

The transfer of mental health services to the health plans resurfaced in 2001-2 as a high priority on the country’s health policy agenda, and the study was brought to the attention of top policymakers involved in efforts to implement the change. In this second round, policymakers developed a clearer conceptual framework for the decisions facing them, had a better understanding of how data could help in the decisions, and took steps to make the necessary data available. In addition, the data discourse appears to have been more open and effective than it had been in the mid-90s.

In January 2003 the government made a decision, in principle, to effect the transfer, but various issues still need to be resolved before implementation can proceed. It is expected that the study’s findings will promote more systematic and collaborative utilization of information and data to support and accompany the transfer’s implementation.

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

Citations in the professional and academic literature

Aviram, U., Guy, D., & Sykes, I. (2007). Risk avoidance and missed opportunities in mental health reform: The case of Israel. International journal of law and psychiatry30(3), 163-181.

אבירם, א., גיא, ד., סייקס, י., Aviram, U., Guy, D., & Sykes, I. (2006). A Missed Opportunity in Mental Health Reform in Israel, 1995-1997/הרפורמה במדיניות בריאות הנפש, 1995—1997: הזדמנות שהוחמצה. ביטחון סוציאלי, 53-83.