Clinic Decentralization: An Israeli Model and Evaluation Strategy

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Abstract
Presents a model for clinic decentralization, implemented by Israel′s largest health insurance fund, Kupat Holim Clalit (KHC). The main elements of the model are: allocation of a fixed budget; delegation of authority for budget utilization and service delivery; provision of incentives for fiscal responsibility; and establishment of an internal information system. Explores expected outcomes of decentralization on the basis of an extensive literature review. Emphasizes the importance of evaluating such an organizational change, and outlines an evaluation strategy. A major concern in this strategy is to control for the effects of changes taking place at the same time‐as decentralization, and the effects of background variables such as demographic characteristics, health status, etc. For this purpose, a quasi‐experimental design was developed, based on the comparison of an experimental and control clinic, both before and after decentralization.