A consumer-based tool for evaluating the quality of health services in the Israeli health care system following reform

Many countries have reformed their health care systems in the past decade and, as such, the need to monitor health system performance is widely recognized. In this paper we present a method for constructing quality indicators, which were used to evaluate the reformed Israeli health care system, and demonstrate the sensitivity of these indicators to change over time and to differences in quality among health plans and among population groups. The quality indicators were developed based on consumers' reports of their experiences in the health system. The indicators were measured in periodic population telephone surveys conducted between August and October of 1995, 1997, and 1999, using a structured questionnaire in Hebrew, Arabic, or Russian, this ensured the inclusion of all major sub-groups of Israel's population. Between 1080 and 1749 people were interviewed, with a response rate of over 80% each year. Using the theory-based evaluation approach, we specified the plausible causal links among intervention (components of the National Health Insurance Law), intermediate outputs (changes in health plan organizational behavior), and consumer outcomes. This led to the identification of indicators of quality of ambulatory health services, which included measures of accessibility, availability, patient satisfaction, performance of preventive medicine, and utilization of private medical services. The consumer-based evaluation tool presented in this paper was found to be easy to apply, sensitive, and relatively inexpensive. We hope that our approach will be of use to other countries that want to evaluate system-wide change and monitor quality of services over time.