Researchers: Rachel Wilf-Miron¹, Shlomit Avni², Liora Valinski²

Background: Considerable disparities have been reported in health and health services, between communities, populations, and regions of Israel

Objectives: The Objective of this study was to describe the process of reaching a consensus among experts and stakeholders on a limited set of national indicators, reflecting equity in health services and health outcomes

Method: The study was designed as a multistage research. A) Identifying appropriate disparity measures. B) Agreement on the screening criteria and relative weight. C) Constructing the consultation framework as an on-line 3-round Delphi technique.

Findings: Thirty measures of disparity, presented to participants, belonged to the following domains: Health promotion (11 indicators); acute and chronic morbidity (11), life expectancy and mortality (2), health infrastructures, care and affordability (4); education and employment (2). Three "voting" rounds took place between February-May 2020. Of 77 contacted, 75 (97%) expressed willingness to participate. In the first round, 72 (96%) completed the survey and in the last round 55 - (74% of those invited to participate).
The leading ten indicators were: Diabetes care; childhood obesity, adult obesity, healthcare personnel, fatal childhood injuries, smoking infant mortality, inability to afford treatment or medication; access to mental health services; hospital beds. Agreement among raters (ICC) was 0.75.

Conclusions: The process succeeded in allocating sociodemographic and health characteristics to areas of residence using geographic information system. Diversity of participating experts and patient representatives allowed for a multidisciplinary, multi-level panel. The high response rate and good level of agreement between participants may facilitate acceptance and assimilation of the research output. The final list of 10 measures represents structure, process and outcomes and gives considerable weight to measures that lie at the interface between healthcare and other sectors.

Recommendations: The research produced a diverse set of indicators that could promote inter-sectoral collaboration at the level of Ministries and in the field. The process and its products may be introduced to policy-makers, especially in the HMOs; the selected measures should be incorporated into the MOH's Business Intelligence infrastructures, to allow monitoring over time of the effect of intervention, designed to reduce health disparities.

Research end date: 06/2020