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Objectives:In a resource-constrained reality, physicians are facing polar demands?those of healthcare managements to adopt cost-conscious behaviors and those of ethical standards that obligate physicians to consider only their patients' best interests. In our study, we aimed to determine the attitudes, practices, and knowledge of healthcare costs among Israeli physicians.Methods:A questionnaire was developed and mailed to a representative sample of physicians in Israel. The overall response rate was 51 percent. The study reviewed self-reported levels of cost consciousness in practice, attitudes, obstacles related to cost containment, and knowledge of the costs of medical resources.Results:Forty-two percent of the physicians reported high levels of cost consciousness in their daily practice; 70 percent reported greater current cost consciousness in comparison to 5 years ago; 76 percent of the responses legitimized institutional demands for cost containment. Although 83 percent of the physicians that responded expressed the belief that economic thinking was inherently the role of management, only 39 percent thought it was part of the physician's role. It was found that predominant predictors of agreement to cost consciousness concepts were employment by a community health plan, a managerial position, participation in health economics seminars, and male gender.Conclusions:Cost consciousness among physicians is related to a broad array of parameters. Interventions must emphasize the benefits of evidence-based medicine as an anchor for both cost containment and quality care, as well as providing assistance to physicians in accepting economic decision-making as part of their professional role. [ABSTRACT FROM AUTHOR]

Background: Limited health budgets and continual advancement of health technologies require mechanisms for prioritization. Israel, with a publicly funded health service basket, has implemented and optimized such a health technology assessment process since 1999.We describe the process of evaluating technologies according to the Israeli model, analyze its outputs and benefits over two decades of implementation, and compare its key features with international experience., Methods: Retrospective data were collected between 1998 and 2023, including work processes, committee composition, number of applications submitted and approved by a clinical domain, and yearly cost of the basket. Features were evaluated within the evidence-informed deliberative process (EDP) framework., Results: This national model involves relevant stake holders in a participatory and transparent process, in a timely manner, and is accepted by the public, health professionals, and policy makers, facilitating early adoption of the newest medical technologies. Between 11 and 19 percent of applications are approved for reimbursement annually, mostly pharmaceuticals. On average 26 percent of approved technologies are added to the list without additional budget. Major domains of approved technologies were oncology, cardiology, and neurology., Conclusions: Israel created a unique model for the expansion of the health service basket. Despite an increasing number of applications and rising costs, the mechanism enables a consensus to be reached on which technologies to fund, while remaining within budget constraints and facilitating immediate implementation. The process, which prioritizes transparency and stake holder involvement, allows just a resource allocation while maximizing the adoption of novel technologies, contributing to an outstanding national level of health despite relatively low health spending.

Objectives: The aim of this study was to describe the history and present situation with health technology assessment (HTA) in Israel., Methods: The method used in this study was a historical analysis based mainly on the knowledge of the authors, but supplemented by the published literature., Results: HTA originated in Israel as a centralized function conducted under the auspice of research, developing into an active multidisciplinary center. Throughout the expansion of the field, HTA was performed in affiliation with several local and international bodies, while providing direct and indirect support at the national level. Today, mainly as a result of vigorous dissemination of the principles, methodology and tools for HTA by the Israeli Center for Technology Assessment in Health Care (ICTAHC), this discipline is increasingly a decentralized activity conducted by a great variety of institutions. Israeli health policy decisions are increasingly based on the results of HTA., Conclusions: ICTAHC's role and functioning has expanded since its beginnings. HTA has become an important part of health care in Israel.

Objectives: The aim of this study was to estimate the impact of new medical technologies on public healthcare expenditures in Israel over the period 2000-07., Methods: For each year, government estimates for the costs of new technologies recommended as high-priority for public funding were summarized. The ratio of projected costs of these technologies to total public healthcare expenditures was calculated and compared with actual governmental budget allocations for new technologies., Results: Funding all new high-priority medical technologies would have increased healthcare expenditures by 2.1 percent per year. Government allocations for new technologies raised expenditures by 1.0 percent per year., Conclusions: New medical technologies significantly increase healthcare expenditures in Israel. Budgetary constraints have reduced their actual impact by 52 percent. This study indicates the need for an annual addition of 2 percent to public healthcare budget for funding new high-priority technologies.

The purpose of this article is to define the distinguishing characteristics of food-borne streptococcal pharyngitis by reviewing the literature. The main cause of this infection lies in poor handling and preservation of cold salads, usually those which contain eggs and are prepared some hours before serving. A shorter incubation period and a higher attack rate (51-90%) than in transmission by droplets was noted. The epidemics tend to occur in warm climates and in the hottest months of the year. Streptococcus pyogenes seems to originate from the pharynx or hand lesions of a food handler. In comparison to airborne transmission symptoms such as sore throat, pharyngeal erythema, and enlarged tonsils, submandibular lymphadenopathy are more frequent than coughing and coryza. Seven out of 17 reports revealed an M-untypeable serotype, which may possess virulent characteristics. Penicillin prophylaxis was shown to limit additional spread of the infection. There were no non-suppurative sequels, and suppurative sequels were very rare. We assume that the guidelines for the prevention of food poisoning would apply to food-borne streptococcal pharyngitis. Food handlers should be supervised to ensure they comply with strict rules of preparation and storage of food. Cold salads, especially those containing eggs, should not be left overnight before serving.

An outbreak of trichinosis occurred during January 1995 in a south Lebanese village with a population of 800-1000 persons. The estimated number of persons treated for a Trichinella-like illness was 200. Sixty-three persons sought medical attention at a local infirmary: 44 of them were diagnosed as having trichinosis or suspected trichinosis according to their clinical symptoms, signs and laboratory tests. An environmental investigation indicated that the source of infection was pork obtained from a single butcher in the village and consumed uncooked, as an ingredient of 'kubeniye' (a local dish), during Christmas and New Year's meals. Sera of patients, suspected patients, and asymptomatic controls were tested for the presence of anti-Trichinella antibodies. Eight (89%) of the 9 tested patients were positive, 1 (11%) was negative. Among the 7 suspected patients, 2 (28.5%) were positive, 3 (42.9%) had equivocal results, and 2 (28.5%) were negative. Among the 20 asymptomatic persons, 3 (15%) were positive, 12 (60%) negative and 5 (25%) had equivocal results. Specimens from the implicated pork meat were examined by microscopy and were found to contain encysted larvae of Trichinella spiralis. This outbreak of trichinosis is one of the largest reported. Previous outbreaks in Lebanon occurred under very similar circumstances, indicating a need to control and prevent the trading of pork meat that is not under veterinary control, and to increase the awareness of the population for this problem.