Revital Gross

School-based obesity prevention programs: A meta-analysis of randomized controlled trials

Attempts have been made to reduce childhood obesity through school‐based programs. Systematic reviews of studies until 2006 reported a lack of consistency about effectiveness of such programs. Presented is an updated systematic review and meta‐analysis.

Self-rated health status and health care utilization among immigrant and non-immigrant Israeli Jewish women.

ABSTRACT Introduction: Since 1989, Israel has absorbed over 700,000 Jewish immigrants from the former Soviet Union, among them about 375,000 women. Immigrants are known to have greater and/or different health needs than non-immigrant residents, and to face unique barriers to receiving care. However, research addressing the specific health problems of these immigrant women has been scarce. Objectives: To compare self-reported health status and health care utilization patterns among immigrant and non-immigrant Israeli Jewish women; and to explore ways to overcome existing barriers to their care. Methods: A telephone survey was conducted in September and October 1998 among a random national sample of women age 22 and over, using a standard questionnaire. In all, 849 interviews were completed, with a response rate of 84%. In this article we present comparative data from a sub-set that included 760 immigrant respondents from the former Soviet Union and non-s immigrant Jewish respondents. Results: A greater proportion of immigrant versus non-immigrant women reported poor perceived health status (17% vs. 4%), chronic disease (61% vs. 38%), disability (31% vs. 18%) and depressive mood symptoms (52% vs. 38%). Lower rates of immigrant women visited a gynecologist regularly (57% vs. 83%) and were satisfied with their primary care physician. Lower rates of immigrants reported discussing health promotion issues such as smoking, diet, physical activity, HRT, and calcium intake with their physician. The article concludes with a discussion of the implications of the findings for designing services that will effectively promote immigrant womens health, both in Israel and elsewhere.

Reforming the Israeli health system: findings of a 3-year evaluation

Israel, like many other European countries, has recently reformed its health care system. The regulated market created by the National Health Insurance (NHI) law embodies many of the principles of managed competition. The purpose of this paper is to present initial findings from an evaluation of the first 3 years of the reform (1995-1997) regarding the implementation of the reform and the extent to which it has achieved its main goals. The evaluation was conducted using multiple quantitative and qualitative research tools: interviews with key informants; analysis of documents and sick fund financial statements; analysis of trends in sick fund membership; and population surveys conducted in 1995 and 1997 to assess the impact of the reform on outcome measures related to level of services to the public. Data from the evaluation show that the NHI law achieved a considerable number of its goals: to provide insurance coverage for the entire population, to ensure freedom of movement among sick funds, and to standardize the way resources are allocated to sick funds. The incentives that are embodied in the law have encouraged the sick funds to improve the level of services provided to the average insuree, and to develop services in the periphery and for some of the weaker populations. From the financial perspective, concerns that NHI would lead to a rise in the national health expenditure were not realized as of 1997. In the wake of NHI, there has been a decline in the age adjusted per capita expenditure in three sick funds, with no reports by insurees, at least through 1997, on a decline in satisfaction or level of service. However, the Israeli experience shows that regulating competition does not necessarily lead to economic stability and equality. Regulating the competition also did not solve some of the major policy issues in the Israeli health system including level of resources allocated to health, organizational structure of the hospital system, manpower planning and the extent of government involvement in system. Additional policy changes may be needed to resolve these issues. Up-to-date information is essential in helping policymakers track the process of reform implementation and results, and identify problems which need to be addressed in the future.

Implementing managed competition in Israel.

As of January 1, 1995, Israels National Health Insurance (NHI) Law laid the foundations for regulating competition among the countrys four private, not-for-profit sick funds. Prior to NHI the sick funds (SFs) had competed without governmental control. Extensive research on NHI implementation and the behavior of the sick funds (SFs) after passage of NHI reveals a paradoxical development: The NHI bill drew on the rhetoric of managed competition and did indeed establish a legal and structural framework for regulating competition among the SFs. Nevertheless, in practice, SF autonomy was constrained and competition over provision of statutory care was limited. Rather than fostering competition, the main thrust of the NHI reforms was to enhance central governments control over SF expenses in order to constrain government expenditures. The NHI reforms did encourage the SFs to cut costs and make visible service improvements. However, the reforms did not lead the SFs to reorganize, expand the scope of their services, or improve clinical quality, as the reformers had hoped. Nor did the reforms help eliminate the SFs operating deficits or insure financial stability for the whole health system. Furthermore, the reforms had unanticipated and undesired outcomes, including aggressive and illegal marketing by SFs and collaboration among SFs to restrict the extent of care provided under compulsory insurance. The Israeli case suggests that the theory of managed competition contains unrealistic assumptions about the types of competitive behavior that result from exposure to managed competition and the capacity of government and health providers to monitor quality. In addition to stemming from universal limitations to the managed competition model, the implementation pattern in Israel reflects local, historical forces and the interplay of Israels powerful health system actors.

Population-based trends in male adolescent obesity in Israel 1967-2003.

Obesity increased monotonically from 1.2% to 3.8% of males age 17 (1967-2003). Low socioeconomic status had an independent positive effect on obesity. The likelihood of obesity had risen more steeply over time among the low socioeconomic status group than among other adolescents. Rise in obesity, standard of living, and income inequality (as measured by the Gini index) increased concomitantly.

Health and Depression in Women from the Former Soviet Union Living in the United States and Israel

Postimmigration adjustment is affected by demographic and health characteristics, as well as national resources. Since 1989, more than a million people emigrated from the former Soviet Union (FSU) to the United States and Israel. These countries differ substantially in health systems and immigrant benefits. The purpose of this study is to compare depressed mood between midlife women from the FSU who reside in the United States and Israel, controlling for demographic and health characteristics. The analysis includes 72 women, 36 from each country, who comprise subsets of larger studies and were matched on age and years since immigration. Women were aged 42–70, and immigrated fewer than 8 years prior to recruitment. Using multiple regression analyses it was found that living in the United States, having lower self-reported health status, and having arthritis predicted higher depression scores. Future cross-national interdisciplinary research should be directed toward identifying specific contextual factors that will guide interventions and influence health policy for new immigrants.

Disparities in obesity temporal trends of Israeli adolescents by ethnic origin

OBJECTIVE To analyze the temporal trends of obesity over time among male adolescents of different ethnic origins. METHODS Population-based national data of subjects presenting at recruitment centers for medical examinations as part of screening for military draft. Subjects were 17-year-old Jewish males (n=1 140 937) born in the years 1950-1986. Data on body mass index (BMI) were measured (without clothing and shoes) by physicians. We calculated the prevalence of obesity (BMI 29.4 or higher) for each year by ethnic origin group. A Multinomial logistic regression model was used to estimate the effects of ethnic origin and other risk factors on the likelihood of obesity. RESULTS Over time, obesity rates have risen among all ethnic groups of adolescents. Multinomial regression analysis showed a lower likelihood of obesity among those of Asia-Africa origin as compared with other groups. However, obesity rates have increased more significantly over time among this ethnic group compared with the other groups. CONCLUSION A significant finding of this study is the disparities in temporal trends in the likelihood of obesity over time. Among adolescents of Asia-Africa origin the likelihood of obesity increased more steeply over time compared with other groups of adolescents. Health services in Israel should thus consider Asia-African origin as a distinct risk factor and target interventions to prevent future obesity among these adolescents.

Pay-for-performance programs in Israeli sick funds

Purpose – This paper aims to analyze the development of “pay‐for‐performance” (P4P) programs implemented by Israels two largest sick funds, insuring 78 percent of the population.Design/methodology/approach – Analysis of the main features and their evolution over time, the observed outcomes and concerns related to implementing these programs.Findings – Our analysis revealed that although implementation has been successful, both managers and physicians have voiced concerns regarding the effect of measuring clinical performance such as focusing attention on the measured areas while neglecting other areas, and motivating a statistical approach to patient care instead of providing patient‐centered care.Originality/value – The Israeli case provides an interesting example of nation‐wide, long‐term implementation of the pay‐for‐performance program. Therefore, it provides other countries with the opportunity to assess features that may facilitate successful implementation, as well as highlighting issues related t...

The influence of budget-holding on cost containment and work procedures in primary care clinics

In 1990, Kupat Holim Clalit (KHC), Israels largest health insurance fund, initiated a demonstration program for transforming primary care clinics in the Negev district of southern Israel into autonomous budget-holding units. Four program components were implemented in nine clinics: allocation of a fixed budget; expansion of day-to-day decision-making authority; establishment of a computerized information system for producing monthly reports on expenditure; and provision of incentives for budgetary responsibility (returning part of a clinics savings for use at its discretion). The demonstration program had three objectives: budgetary control and cost containment; improvement of services and increased client satisfaction; and improvement in the motivation, initiative, responsibility, and satisfaction of clinic staff. This report presents interim findings from an evaluation study of the budget-holding program conducted in 1991-1992. The report considers three questions: How was the demonstration program implemented? Did work procedures in the clinics change following implementation of the program? How did budget-holding influence levels of expenditure in the clinics? The program components were implemented gradually in the nine clinics during 1991-1992. Not all, however, were fully implemented. The staff survey conducted after implementation of the program identified a number of changes in the work procedures of the clinics: heightened cost consciousness, discussion of the monthly expenditure reports, emphasis on the need to economize, and attempts to economize. Data on expenditure in the budget-holding clinics were analyzed and compared to data on expenditure in primary care clinics in the Negev district as a whole. It was found that while the average quarterly per capita expenses in the district increased in real terms from 1991-1992, expenses in the budget-holding clinics remained stable or, in some cases, actually decreased. While we cannot conclude categorically from the existing data that the budget-holding program is responsible for the unique patterns of expenditure in the nine clinics, we can confidently state that work procedures in the nine clinics changed following implementation of the program and that the clinics achieved cost containment relative to the district as a whole. Findings from the various research tools support one another, and reinforce the conclusion that budget-holding can potentially promote cost containment.

Disparities in women's health and health care experiences in the United States and Israel: findings from 1998 National Women's Health Surveys.

ABSTRACT Objective and Methods: Using data from bi-national 1998 surveys of adult women in the U.S. and in Israel, this article examines health, access, and care experiences among women in two countries with very different health care systems. We examine how well each countrys system serves those vulnerable due to lower socio-economic status. The Israeli health care system-characterized by universal coverage for all its residents-relies on a system of competing health funds that employ many features typical of U.S. managed care plans. The analysis explores the extent to which such a system helps to equalize access experiences with contrasts to the experiences of U.S. women. Findings: We find that U.S. and Israeli women report similar rates of disability and chronic conditions with prevalence of health problems sharply higher for low income and less educated women. We also find disparities in access: women in both countries reported unequal access experiences by education and income. In Israel, these experiences appear to be linked to health plan structural features rather than cost barriers. Conclusion: The findings indicate that achieving more equitable access to health care requires attention to non-financial as well as financial barriers to care. Despite the lack of financial barriers to care in Israel, administrative controls typical of managed care organizations appear to make health care systems difficult to navigate for low income and less educated women. The finding that disparities in health persist in a country with universal coverage indicates that improving womens health will require attention to broader social influences on health as well as improving access to health care.