Researchers: Irit Elroy¹

Background: In assessing reforms it is important to evaluate the extent to which its goals have been achieved. The implementation of the mental health insurance reform was not accompanied by any official statement of goals. Therefore, it is appropriate to examine how various actors perceive the goals of the reform and how they act to realize them. In addition, the actions taken and planned should be monitored and difficulties encountered in the process should be highlighted.

Objectives: To learn: how the goals, achievements and difficulties in implementing the reform are perceived; what the health plans have done to implement the reform; what are the plans for its continued implementation; and what is required for optimal implementation over the coming years.

Method: 38 interviews with officials from the Ministry of Health, the Ministry of Finance, health plans, mental health clinics and nonprofit organizations; review of policy documents relating to reform.

Findings: The reform promoted the normalization of mental health at the health plans, led to an increase in the number of patients treated and a decrease in stigma. There is a difficulty in making services sufficient available due to a shortage of recognized position and a shortage of professionals. There is a blurring of the boundaries between mental health and related areas and disagreement within the system as to which mental health conditions are entitled to treatment. The lack of a clear statement about the basket of services creates differences of opinion regarding the basket's contents.
In order to proceed effectively with the implementation, the array of services should be expanded, the number of recognized position should be increased, quality and impact indices should be developed, and specialized services and alternatives to hospitalization should be developed.

Recommendations: Action should be taken to increase the pool of professionals in areas of shortage; clarify the division of responsibility between mental health services and related services; develop guidelines and standards in areas such as availability and accessibility, continuity of care and integration with primary care, and to promote their implementation through adequate budgeting; and to reduce budgetary uncertainty in the system.

Research end date: 12/2018