Reforming the MRI system: the Israeli National Program to shorten waiting times and increase efficiency.

BACKGROUND: Long waiting times (WT) for Magnetic Resonance Imaging (MRI) are a challenge in many countries and demand is forecast to increase with ageing populations. Since MRI is essential for diagnosis in numerous medical conditions, timely performance is of the utmost importance. OBJECTIVE: To describe the multi-faceted program developed by the Israel Ministry of Health (MoH) to shorten WT for MRI and increase efficiency, and to examine lessons that can be learned for other health systems. DATA SOURCES: Data were obtained from the Israel MoH from 2015-2019. METHODS: The plan used multiple strategies and comprised the following elements: providing additional scanners, dedicating additional personnel to MRI units, maximizing efficiency, establishing a training program for radiographers and a fellowship program for radiologists, introducing financial incentives to health maintenance organizations and implementing a computerized monitoring system. RESULTS: A substantial reduction in mean WT was demonstrated, from 52 days in 2015, to 24 days in 2016 and 2017. This was followed by a slight increase to 26 and 32 days in 2018 and 2019, respectively. The relative decline in WT from 2015 to 2019 was 38.5%. The number of scanners doubled during this period while the number of radiographers and radiologists with formal MRI training increased. CONCLUSIONS: The broad scope of this comprehensive reform was successful in addressing long WT and improving care provision from a wide perspective: economic, workforce and infrastructure. Bottlenecks in the MRI system cannot be addressed from a single angle, rather requiring a whole system approach.

Cancer risk among Holocaust survivors in Israel-A nationwide study.

BACKGROUND: Holocaust survivors during World War II were exposed to various factors that are associated with cancer risk. The objective of this study was to determine whether Holocaust survivors had an increased risk for developing cancer. METHODS: The study population included 152,622 survivors. The main analysis was based on a comparison between individuals who were entitled to compensation for suffering persecution during the war and individuals who were denied such compensation. A complementary analysis compared survivors who were born in countries governed by Nazi Germany with survivors born in nonoccupied countries. A Cox proportional hazards model was used, with the time at risk of cancer development starting on either January 1, 1960, or the date of immigration to the date of cancer diagnosis or death or the date of last follow-up (December 31, 2006). RESULTS: Cancer was diagnosed in 22.2% of those who were granted compensation versus 16% of those who were denied compensation (P < .0001). Adjusting for birth cohort, sex, country of origin, and period of immigration, both analyses revealed significant increased risks of developing cancer in those who were exposed. For those who were granted versus denied compensation, the hazard ratios were 1.06 (P < .001) for all sites, 1.12 (P = .07) for colorectal cancer, and 1.37 (P = .008) for lung cancer. For those born in occupied countries versus nonoccupied countries, the hazard ratios were 1.08 (P < .001), 1.08 (P = .003), and 1.12 (P = .02), respectively. CONCLUSIONS: The current results, based on a large cohort of Holocaust survivors who were exposed to a variety of severe deprivations, add to the conflicting and sparse knowledge on this issue and support the notion that this group has a small but consistent increase in cancer development. Cancer 2017;123:3335-45. © 2017 American Cancer Society.

Early awareness and alert systems for medical technologies in Israel.

BACKGROUND: Throughout the world, decision makers face the need to plan on the basis of uncertainty. Prospective updates on future trends of medical technology usage are tools to improve national health status. In Israel, this challenge is met by several steps taken to promote insight into the realm of emerging technologies. Israel's unique horizon strategy refers to three time spans: the immediate to short-term (for the coming year) updating the National List of Health Services (NLHS) and quarterly scanning; the medium-term (3 years to a decade) revitalizing hospital devices and infrastructure; and long-term planning (over a decade), such as the "Health Israel 2020 Project". METHODS: A description of the Israeli setup of different time spans and tiers. RESULTS: The matrix of players, loci, interests, population groups, and incentives creates a complex situation and the Ministry of Health has to regulate the different suppliers and tiers of insurance (obligatory, supplementary, and private), balancing need, equity, and cost containment in preparing for future health care. However, preparedness is not a sterile laboratory and is pervaded by numerous dilemmas and the search for adequate evidence for new less mature technologies is an on-going challenge. CONCLUSION: Bridging the forecasting chasm for the future requires analyzing needs, reinforcing evidence and seeing "around the corner" when synergizing between all the "actors" in the national arena. Expert consultation and international cooperation with similar horizon organizations can assist in paving the way for more successful planning efforts for future medical technology implementation.