Values, institutions and shifting policy paradigms: Expansion of the Israeli National Health Insurance Basket of Services

Objectives: To examine the roles of policy paradigms, in particular new public management and regulated competition in different areas of health policy. Methods: Quantitative and qualitative methods are used to assess the degree of success of regulated competition in the Israeli context in terms of public understanding, trust, and the basic viability of the system and in somatic as opposed to mental health policy. Results: As Israel's explicit priority setting processes in the area of somatic health services have proceeded, the public indicates increased relative preference for treatments adding quality of life, shifting from prioritizing extending life. The public and physicians gave high scores to preventative screening. Between 1998 and 2001 levels of awareness of the decision-making process rose and then retreated, perhaps due to varying levels of decision-making activity. High levels of trust are evinced in health policy agencies and in the priority setting process. Conclusions: The Israeli case demonstrates that New Public Management (NPM) paradigms, such as regulated competition, can successfully be deployed in attempting to manage health care policy. However, as health policy moves beyond somatic health care into areas requiring more inter-sector orientation, such as mental health, the appropriateness of NPM models is called into question. However, the very success of models such as regulated competition causes policy makers to resort to them instead of developing new paradigms.