title: Financial risk-sharing in updating the National List of Health Services in Israel: stakeholders' perceived interests.
abstract: OBJECTIVE
  Risk-sharing is being considered by many health care systems to address the financial risk associated with the adoption of new technologies. We explored major stakeholders' views toward the potential implementation of a financial risk-sharing mechanism regarding budget-impact estimates for adding new technologies to the Israeli National List of Health Services. According to our proposed scheme, health plans will be partially compensated by technology sponsors if the actual use of a technology is substantially higher than what was projected and health plans will refund the government for budgets that were not fully utilized.
  
  
  METHODS
  By using a semi-structured protocol, we interviewed major stakeholders involved in the process of updating the National List of Health Services (N = 31). We inquired into participants' views toward our proposed risk-sharing mechanism, whether the proposed scheme would achieve its purpose, its feasibility of implementation, and their opinion on the other stakeholders' incentives.
  
  
  RESULTS
  Participants' considerations were classified into four main areas: financial, administrative/managerial, impact on patients' health, and influence on public image. Most participants agreed that the conceptual risk-sharing scheme will improve the accuracy of early budget estimates and were in favor of the proposed scheme, although Ministry of Finance officials tended to object to it.
  
  
  CONCLUSIONS
  The successful implementation of risk-sharing schemes depends mainly on their perception as a win-win situation by all stakeholders. The perception exposed by our participants that risk-sharing can be a tool for improving the accuracy of early budget-impact estimates and the challenges pointed by them are relevant to other health care systems also and should be considered when implementing similar schemes.
authors.affiliation: Department of Health Systems Management, Faculty of Health Sciences and Guilford-Glazer Faculty of Business and Management, Ben-Gurion University of Negev, Beer-Sheva, Israel. arielha@clalit.org.il
authors.forename: Ariel
authors.initials: A
authors.lastname: Hammerman
authors.forename: Paula
authors.initials: P
authors.lastname: Feder-Bubis
authors.forename: Dan
authors.initials: D
authors.lastname: Greenberg
mesh_terms: D020811:Biomedical Technology / Q000191:economics / Q000379:methods*; D002017:Budgets; D003625:Data Collection; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D012051:Reimbursement Mechanisms; D020414:Risk Sharing, Financial / Q000458:organization & administration*