The process of updating the National List of Health Services in Israel: is it legitimate? Is it fair?
OBJECTIVE
The Israeli National Health Insurance Law stipulates a National List of Health Services (NLHS) to which all residents are entitled from their HMOs. This list has been updated annually for almost a decade using a structured review and decision-making process. Although this process has been described in detail in previous papers, none of these have fully addressed legitimacy and fairness. We examine the legitimacy and fairness of the process of updating the NLHS in Israel.


METHODS
We assessed the priority-setting process for compliance with the four conditions of accountability for reasonableness outlined by Daniels and Sabin (relevance, publicity, appeals, and enforcement). These conditions emphasize transparency and stakeholder engagement in democratic deliberation.


RESULTS
Our analysis suggests that the Israeli process for updating the NLHS does not fulfill the appeals and enforcement conditions, and only partially follows the publicity and relevance conditions, outlined in the accountability for reasonableness framework. The main obstacles for achieving these goals may relate to the large number of technologies assessed each year within a short time frame, the lack of personnel engaged in health technology assessment, and the desire for early adoption of new technologies.


CONCLUSIONS
The process of updating the NLHS in Israel is unique and not without merit. Changes in the priority-setting process should be made to increase its acceptability among the different stakeholders.
Greenberg
Dan
D
Department of Health Systems Management, Ben-Gurion University of the Negev, PO Box 653, Beer Sheva 84105, Israel. dangr@bgu.ac.il
Siebzehner
Miriam I
MI
Pliskin
Joseph S
JS
D019992:Databases as Topic / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D003657:Decision Making; D006279:Health Maintenance Organizations; D006296:Health Services; D007557:Israel; D040841:Resource Allocation / Q000592:standards*; D013673:Technology Assessment, Biomedical