title: [Development of an evidence-based managerial decision aid to assist in the provision of secondary medical services in the Israel Defense Forces (IDF)].
abstract: BACKGROUND
  Increasing global expenditures on health, together with increased patient demand for quality and service, have created a need for health care management tools based on economic and quaLity-based criteria. Despite the recognition of this need, decision-support tools are Lacking. In the Israel Defense Forces (IDF), policy change and budgetary and quality constraints necessitated the development of an evidence-based managerial decision aid, to assist in providing medical services at acceptable quality and availability leveLs, while addressing economic concerns.
  
  
  OBJECTIVE
  To develop a decision-support model for the IDF Medical Corps, that balances the conflicting considerations of service avaiLabiLity and cost.
  
  
  METHODS
  The authors developed a manageriaL model to characterize regional secondary medical care, and to compare it to country-wide patterns and to historic regional patterns. Secondary care systems were then analyzed by specialty. Finally, the relative costs of medical encounters for each speciaLty were anaLyzed.
  
  
  RESULTS
  Core specialties examined included dermatology, orthopedics and otolaryngology. Two-thirds of all referrals to core specialists were made to intra-organizational resources. Furthermore, several intra-organizationaL clinics were found to have short waiting times and low output indices. In response to the application of the model, IDF Medical Corps policy was updated and suppliers were reprioritized, yielding substantial savings of up to NIS 5.5 million in 2006 alone. This cost saving enabled budgetary reallocation and alternative investment in the emergency and primary health care systems.
  
  
  CONCLUSIONS
  Applying efficient managerial tools can lead to cost savings and to increased quality and availability of services. These tools must effectively follow changes in the dynamics of the health care system. These changes are to be impLemented rapidly, in order to provide practical guidance for medical administrators and to enable them to infLuence the real-time utiLization of medical services.
authors.affiliation: Health Service and Equipment Center, IDF. ilangreen.md@gmail.com
authors.forename: Ilan
authors.initials: I
authors.lastname: Green
authors.forename: Michael
authors.initials: M
authors.lastname: Huerta
authors.forename: Yosefa
authors.initials: Y
authors.lastname: Bar-Dayan
authors.forename: Gil
authors.initials: G
authors.lastname: Fire
mesh_terms: D003365:Costs and Cost Analysis; D004470:Economics, Medical; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D006291:Health Policy / Q000191:economics; D006801:Humans; D007557:Israel; D008511:Medicine / Q000458:organization & administration; D008887:Military Medicine / Q000191:economics / Q000458:organization & administration*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013038:Specialization; D014850:Waiting Lists