David Chinitz holds a PhD in Public Policy Analysis from the University of Pennsylvania and is a Professor of Health Policy and Management at the School of Public Health of the Hebrew University and Hadassah in Jerusalem. His research and publications are in the areas of comparative health system reform, health care priority setting, management of cancer services, mental health policy, and the impact of quality improvement programs at the level of front line staff in community and hospital settings. He has consulted for the World Health Organization, and served as President of the International Society for Priority Setting in Health Care, and Chair of the Scientific Advisory Board of the European Health Management Association, as well as serving on the editorial advisory boards of Health Economics, Policy and Law and the Israel Journal of Health Policy Research. In addition to 125 publications, book chapters and edited books, Chinitz has authored over 60 Oped pieces in prominent journals on subjects covering from the Israeli health system, Israeli politics, immigration to Israel, and sports, and is a well known stand up comedian in Jerusalem and New York City.
We are pleased that our recent paper, On Health Policy and Management (HPAM): mind the theorypoli... more We are pleased that our recent paper, On Health Policy and Management (HPAM): mind the theorypolicy-practice gap (1), generated lively discussion. Most prominent among the respondents were Professors Jean de Kervasdoué (2) and David Hunter (3).
Richard Saltman and Antonio Duran take up the challenging issue of governance in their article “G... more Richard Saltman and Antonio Duran take up the challenging issue of governance in their article “Governance, Government and the Search for New Provider Models,” and use two case studies of health policy changes in Sweden and Spain to shed light on the subject. In this commentary, I seek to link their conceptualization of governance, especially its interrelated roles at the macro, meso, and micro levels of health systems, with the case studies on which they report. While the case studies focus on the shifts in governance between the macro and meso levels and their impacts on achievement of desired policy outcomes, they also highlight the need to better integrate the dynamics of day to day operations within micro organizations into the overall governance picture.
Current reforms of the Israeli health system seek to improve its efficiency, quality and responsi... more Current reforms of the Israeli health system seek to improve its efficiency, quality and responsiveness. Access to a basic basket of health services will be guaranteed to all citizens under National Health Insurance. Competing sick funds will provide the basic package in ...
This position paper is intended to suggest starting points for discussion regarding three issues:... more This position paper is intended to suggest starting points for discussion regarding three issues: (A) background considerations related to development of an MPH health policy curriculum; (B) subjects to be considered for inclusion in MPH health policy curricula; (C) teaching methods.
The process by which services are added to Israel's basic basket of health services constitutes a... more The process by which services are added to Israel's basic basket of health services constitutes a unique effort to tackle the most difficult of ethical issues. In some years, since 1997, the Israeli government allocated an increment of about 1% to the national health budget for the purpose of expanding the basic basket of health services provided under national health insurance. A public committee has been created for this purpose of deciding which of hundreds of potential entrants, should be added within the above budget constraint. The committee integrates available scientific evidence on effectiveness with social values to come up with a ranking. The process has attracted a great deal of public attention, most notably in the printed media, which usually focuses on the plight of specific individuals whose "desired drug" has not been added to the basket. In addition, the courts have, on occasion, intervened to reverse decisions of the committee in the contexts of suits brought by individuals seeking coverage for a treatment not currently included in the basket. Thus, Israel's brave attempt to cope with the necessity of health care rationing needs to be fine-tuned in terms of the information provided to the public about the process and the balance of scientific, economic, judicial and political inputs into the process.
Background: Current guidelines for the treatment of uncomplicated urinary tract infection (UTI) i... more Background: Current guidelines for the treatment of uncomplicated urinary tract infection (UTI) in women recommend empiric therapy with antibiotics for which local resistance rates do not exceed 10–20%. We hypothesized that resistance rates of Escherichia coli to fluoroquinolones may have surpassed this level in older women in the Israeli community setting. Objectives: To identify age groups of women in which fluoroquinolones may no longer be appropriate for empiric treatment of UTI. Methods: Resistance rates for ofloxacin were calculated for all cases of uncomplicated UTI diagnosed during the first 5 months of 2005 in a managed care organization (MCO) in Israel, in community-dwelling women aged 41–75 years. The women were without risk factors for fluoroquinolone resistance. Uncomplicated UTI was diagnosed with a urine culture positive for E. coli. The data set was stratified for age, using 5 year intervals, and stratum-specific resistance rates (% and 95% CI) were calculated. These data were analyzed to identify age groups in which resistance rates have surpassed 10%. Results: The data from 1291 urine cultures were included. The crude resistance rate to ofloxacin was 8.7% (95% CI 7.4 to 10.2). Resistance was lowest among the youngest (aged 41–50 y) women (3.2%; 95% CI 1.11 to 5.18), approached 10% in women aged 51–55 years (7.1%; 95% CI 3.4 to 10.9), and reached 19.86% (95% CI 13.2 to 26.5) among the oldest women (aged 56–75 y). Conclusions: Physicians who opt to treat UTI in postmenopausal women empirically should consider prescribing drugs other than fluoroquinolones. Concomitant longitudinal surveillance of both antibiotic utilization patterns and uropathogen resistance rates should become routine practice in this managed-care organization.
We are pleased that our recent paper, On Health Policy and Management (HPAM): mind the theorypoli... more We are pleased that our recent paper, On Health Policy and Management (HPAM): mind the theorypolicy-practice gap (1), generated lively discussion. Most prominent among the respondents were Professors Jean de Kervasdoué (2) and David Hunter (3).
Richard Saltman and Antonio Duran take up the challenging issue of governance in their article “G... more Richard Saltman and Antonio Duran take up the challenging issue of governance in their article “Governance, Government and the Search for New Provider Models,” and use two case studies of health policy changes in Sweden and Spain to shed light on the subject. In this commentary, I seek to link their conceptualization of governance, especially its interrelated roles at the macro, meso, and micro levels of health systems, with the case studies on which they report. While the case studies focus on the shifts in governance between the macro and meso levels and their impacts on achievement of desired policy outcomes, they also highlight the need to better integrate the dynamics of day to day operations within micro organizations into the overall governance picture.
Current reforms of the Israeli health system seek to improve its efficiency, quality and responsi... more Current reforms of the Israeli health system seek to improve its efficiency, quality and responsiveness. Access to a basic basket of health services will be guaranteed to all citizens under National Health Insurance. Competing sick funds will provide the basic package in ...
This position paper is intended to suggest starting points for discussion regarding three issues:... more This position paper is intended to suggest starting points for discussion regarding three issues: (A) background considerations related to development of an MPH health policy curriculum; (B) subjects to be considered for inclusion in MPH health policy curricula; (C) teaching methods.
The process by which services are added to Israel's basic basket of health services constitutes a... more The process by which services are added to Israel's basic basket of health services constitutes a unique effort to tackle the most difficult of ethical issues. In some years, since 1997, the Israeli government allocated an increment of about 1% to the national health budget for the purpose of expanding the basic basket of health services provided under national health insurance. A public committee has been created for this purpose of deciding which of hundreds of potential entrants, should be added within the above budget constraint. The committee integrates available scientific evidence on effectiveness with social values to come up with a ranking. The process has attracted a great deal of public attention, most notably in the printed media, which usually focuses on the plight of specific individuals whose "desired drug" has not been added to the basket. In addition, the courts have, on occasion, intervened to reverse decisions of the committee in the contexts of suits brought by individuals seeking coverage for a treatment not currently included in the basket. Thus, Israel's brave attempt to cope with the necessity of health care rationing needs to be fine-tuned in terms of the information provided to the public about the process and the balance of scientific, economic, judicial and political inputs into the process.
Background: Current guidelines for the treatment of uncomplicated urinary tract infection (UTI) i... more Background: Current guidelines for the treatment of uncomplicated urinary tract infection (UTI) in women recommend empiric therapy with antibiotics for which local resistance rates do not exceed 10–20%. We hypothesized that resistance rates of Escherichia coli to fluoroquinolones may have surpassed this level in older women in the Israeli community setting. Objectives: To identify age groups of women in which fluoroquinolones may no longer be appropriate for empiric treatment of UTI. Methods: Resistance rates for ofloxacin were calculated for all cases of uncomplicated UTI diagnosed during the first 5 months of 2005 in a managed care organization (MCO) in Israel, in community-dwelling women aged 41–75 years. The women were without risk factors for fluoroquinolone resistance. Uncomplicated UTI was diagnosed with a urine culture positive for E. coli. The data set was stratified for age, using 5 year intervals, and stratum-specific resistance rates (% and 95% CI) were calculated. These data were analyzed to identify age groups in which resistance rates have surpassed 10%. Results: The data from 1291 urine cultures were included. The crude resistance rate to ofloxacin was 8.7% (95% CI 7.4 to 10.2). Resistance was lowest among the youngest (aged 41–50 y) women (3.2%; 95% CI 1.11 to 5.18), approached 10% in women aged 51–55 years (7.1%; 95% CI 3.4 to 10.9), and reached 19.86% (95% CI 13.2 to 26.5) among the oldest women (aged 56–75 y). Conclusions: Physicians who opt to treat UTI in postmenopausal women empirically should consider prescribing drugs other than fluoroquinolones. Concomitant longitudinal surveillance of both antibiotic utilization patterns and uropathogen resistance rates should become routine practice in this managed-care organization.
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