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Presents a model for clinic decentralization, implemented by Israel′s largest health insurance fund, Kupat Holim Clalit (KHC). The main elements of the model are: allocation of a fixed budget; delegation of authority for budget utilization and service delivery; provision of incentives for fiscal responsibility; and establishment of an internal information system. Explores expected outcomes of decentralization on the basis of an extensive literature review. Emphasizes the importance of evaluating such an organizational change, and outlines an evaluation strategy. A major concern in this strategy is to control for the effects of changes taking place at the same time‐as decentralization, and the effects of background variables such as demographic characteristics, health status, etc. For this purpose, a quasi‐experimental design was developed, based on the comparison of an experimental and control clinic, both before and after decentralization.

In 1988, Israel’s largest sick fund embarked on a process of decentralization, which consisted of the delegation of authority from central management to two regions that were chosen as demonstration sites. Aims to examine the extent to which the decentralization plan was implemented, to identify the major difficulties in implementation and to evaluate the process of implementing organizational change. Contends that the demonstration programme was implemented in part only, and that difficulties did arise during implementation. Our evaluation of the decentralization process led us to develop conceptual diagnoses of the various problems that might arise during decentralization and derive lessons for successful implementation. Evaluation taught us that when implementing a plan of decentralization, it is beneficial to make a clear division of responsibilities; develop control instruments and an information infrastructure; improve the skills of managers; appoint a team responsible for implementing decentralization, and establish a joint forum for working out problems between central management and sub‐units; and clarify organizational policy on the central operational issues facing sub‐units. Expresses the hope that the conclusions drawn here will help other organizations in Israel and abroad in planning and implementing decentralization.

This paper aims to analyze the development of “pay‐for‐performance” (P4P) programs implemented by Israel's two largest sick funds, insuring 78 percent of the population.

Analysis of the main features and their evolution over time, the observed outcomes and concerns related to implementing these programs.

Our analysis revealed that although implementation has been successful, both managers and physicians have voiced concerns regarding the effect of measuring clinical performance such as focusing attention on the measured areas while neglecting other areas, and motivating a statistical approach to patient care instead of providing patient‐centered care.

The Israeli case provides an interesting example of nation‐wide, long‐term implementation of the pay‐for‐performance program. Therefore, it provides other countries with the opportunity to assess features that may facilitate successful implementation, as well as highlighting issues related to the outcomes of P4P programs.

This article aims to analyze existing and preferred labor divisions between physicians and nurses treating patients with hypertension and diabetes in managed care organizations.

A mail survey was conducted in 2002/2003 among a representative sample of 743 physicians employed by Israel's largest managed care health plans (78 percent response rate). A telephone survey among a representative sample of 1,369 hypertensive or diabetic patients (77 percent response rate) was also used.

Findings reveal a conspicuous gap between actual labor division and what physicians perceive to be ideal. Possible reasons for this gap are discussed and strategies for facilitating collaboration, which would improve service quality as well as work life quality for both physicians and nurses.

This study provides empirical data on the extent of nurse involvement in managed care organization chronic patient care, as well as comparing them to physicians' preferences regarding nurse involvement.

A budget‐holding program was implemented in nine primary care clinics in the Negev district of Kupat Holim Clinic, Israel’s largest sick fund. This study, carried out from 1991 to 1994, evaluates the impact of this program on patient satisfaction and other selected indicators of quality of care, using a controlled case study methodology. Structured questionnaires were used in face‐to‐face interviews with a representative stratified sample of 523 patients registered in the clinics. Patient reports were used to measure patient satisfaction, accessibility of services, comprehensiveness of care, responsiveness to patients’ needs and performance of preventive medicine activities. Other research tools included staff surveys, in‐depth interviews and administrative data on transfer among sick funds. The findings counter fears that budgetary control and cost‐containment negatively affect quality of care and patient satisfaction. However, the program did not fulfill expectations regarding improvement in clinic services and patient satisfaction.

Assesses the degree of self‐reported implementation of gatekeeping in clinical practice, and gains insight into primary care physicians’ attitudes toward gatekeeping and their perceptions of necessary conditions for implementation of gatekeeping in daily practice. A self‐administered questionnaire was mailed to a national sample of 800 primary care physicians in Israel, with a response rate of 86 per cent. Multivariate analysis indicated that sick fund affiliation was the main predictor of self‐reported implementation of gatekeeping, while specialty training predicted primary care physicians’ attitude toward this role. Close communication with specialists, continuous medical education, and management support of physician decisions were identified by respondents as being important conditions for gatekeeping. Discusses strategies to gain the cooperation of primary care physicians, which is necessary for implementing an effective gatekeeping system.

The purpose of this paper is to identify the factors that contribute to the success or failure of quality assurance programs implemented by Israeli managed care health plans.

An in‐depth study of seven quality assurance programs was conducted, comparing successful with unsuccessful ones using the comparative “case study” method. Employing a semi‐structured questionnaire, 42 program directors and professionals in the field were interviewed.

A number of factors associated with the programs' success emerged. Those external to the program included: ongoing management support, resource allocation, information system support and perceived financial benefit for the organization. Internal factors included: leadership, perceived problem's importance, laying the groundwork in the field, involving field staff in planning and implementation and staff motivation.

The study provides insights into ways to encourage the implementation of successful quality assurance programs in the special organizational context of managed care health plans. As the implementation relies heavily on data, one important precondition is the development of computerized information systems to facilitate ongoing data collection. It is also necessary from the planning stage to take into account organizational factors that affect success.

It is widely accepted that educational leaders and teachers need to manage and regulate their emotions continually, mainly because schooling and teaching processes expose many emotions. Thus, the purpose of this paper is to trace the ways Israeli assistant principals, both Arab and Jewish, manage their emotions at work.

Based on semi-structured interviews with 15 assistant principals, it was found that they are required to manage their emotions in accordance with entrenched emotion rules in the culture and society.

Most of the Jewish female APs tend to display warmth and empathy toward teachers in order to better understand their personal needs and professional performances. In contrast, Arab APs suppressed or fabricated emotional expression in their discourse with teachers and parents, in order to maintain a professional façade and retain the internal cohesion of the school. Both groups of APs believed their emotion regulation results in higher level of harmony in the school. Empirical and practical suggestions are put forward.

The paper is original and contributes to the theoretical and practical knowledge.