Ostensibly, no health systems could be more different from each other than those of Israel and the State of California. However, ongoing health system reforms in both places show more convergence than meets the eye, especially in reliance on some form of regulated competition. Both systems have witnessed public backlash against coverage decisions made by managed care organizations. Trust has emerged as an important issue in both systems. This paper examines and compares the symbiotic relationship between trust and various innovations in rationing of health services and priority setting, that have either been implemented or are under discussion in two health systems. Data is drawn from in depth interviews with key informants in both systems including health plan directors, consumer advocates, regulators, politicians and researchers. Respondents are asked to give their views on determination of covered benefits. Attitudes of the respondents to trust in the health system are elicited from their comparative assessments of different options for structuring health policy and regulation. Survey data on public and physician attitudes towards rationing in the two systems is also presented and analyzed. The California-Israel comparison is put in the context of the growing international literature on priority setting in health care. The major conclusion is that priority setting and rationing must be based on a combination of technical inputs and public deliberation that can preserve trust and promote accountability.
Learning Objectives: N/A
Keywords: Rationing, Health Care Reform
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.