title: Reorganization of secondary medical care in the Israeli Defense Forces Medical Corps: A cost-effect analysis.
abstract: OBJECTIVE
  To increase accessibility and availability of secondary medical care, 10 secondary unit specialist clinics were established side-by-side with five existing regional specialist centers, thus achieving decentralization. The purpose was to analyze the impact of this reorganization on overall consumption of secondary medical care and expenditures.
  
  
  METHODS
  Consumption of secondary medical care was analyzed by using computerized clinic and Medical Corps databases. Functional efficiency and budgetary expenditures were evaluated in four representative unit specialist clinics.
  
  
  RESULTS
  The reorganization resulted in an 8% increase in total secondary care consumption over 2.5 years. The establishment of unit specialist clinics did not achieve increased accessibility or availability for military personnel. Functional analysis of representative unit specialist clinics showed diversity in efficiency, differences in physicians' performance, and excess expenditures.
  
  
  CONCLUSIONS
  The decentralizing reorganization of secondary medical care generated an increase in medical care consumption, possibly because of supply-induced demand. The uniform inefficiency of the unit specialist clinics might have been related to incorrect planning and management. The decentralization of secondary medical care within the Israeli Defense Forces has not proved to be cost-efficient.
authors.affiliation: Medical Services and Supply Center, Medical Corps, Israeli Defense Forces, Beer-Sheba, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Yagil
authors.forename: Ronen
authors.initials: R
authors.lastname: Arnon
authors.forename: Vered
authors.initials: V
authors.lastname: Ezra
authors.forename: Isaac
authors.initials: I
authors.lastname: Ashkenazi
mesh_terms: D003362:Cost-Benefit Analysis; D019992:Databases as Topic; D006279:Health Maintenance Organizations / Q000458:organization & administration* / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007557:Israel; D008511:Medicine / Q000458:organization & administration* / Q000706:statistics & numerical data; D008887:Military Medicine / Q000191:economics / Q000458:organization & administration*; D009819:Office Visits; D012041:Regional Medical Programs / Q000191:economics / Q000458:organization & administration*; D013038:Specialization; D014600:Utilization Review