Decentralization in a sick fund: lessons from an evaluation.
In 1988, Israel's largest sick fund embarked on a process of decentralization, which consisted of the delegation of authority from central management to two regions that were chosen as demonstration sites. Aims to examine the extent to which the decentralization plan was implemented, to identify the major difficulties in implementation and to evaluate the process of implementing organizational change. Contends that the demonstration programme was implemented in part only, and that difficulties did arise during implementation. Our evaluation of the decentralization process led us to develop conceptual diagnoses of the various problems that might arise during decentralization and derive lessons for successful implementation. Evaluation taught us that when implementing a plan of decentralization, it is beneficial to make a clear division of responsibilities; develop control instruments and an information infrastructure; improve the skills of managers; appoint a team responsible for implementing decentralization, and establish a joint forum for working out problems between central management and sub-units; and clarify organizational policy on the central operational issues facing sub-units. Expresses the hope that the conclusions drawn here will help other organizations in Israel and abroad in planning and implementing decentralization.
Gross
R
R
JDC-Brookdale Institute, Jerusalem, Israel.
Rosen
B
B
D003659:Decision Making, Organizational; D017598:Efficiency, Organizational; D006302:Health Services Research / Q000379:methods; D007557:Israel; D008330:Management Audit; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D009936:Organizational Innovation; D016134:Organizational Policy; D011635:Public Health Administration; D011787:Quality of Health Care; D018855:Single-Payer System / Q000458:organization & administration* / Q000592:standards