By Uri Aviram
The Paul Baerwald School of Social Work and Social Welfare
The Hebrew University of Jerusalem, Jerusalem, Israel
Dalia Guy
Faculty of Social Sciences, School of Political Sciences,
University of Haifa, Haifa, Israel
and Israel Sykes, Turningpoint: Systems Learning for Success, Joint-Brookdale Institute, Jerusalem, Israel
The passage of the National Health Insurance Law (NHI - 1994) provided a window of opportunity for mental health reform in Israel. The reform was based on inclusion and mainstreaming principles of mental health services and called for transfer, within a period of three years, of responsibility for psychiatric services formerly provided mostly by the Ministry of Health, to Israel's four major sick funds. Planners of mental health reform in Israel saw in the NHI Law and particularly its principles of timely, accessible and equitable health services provision as an opportunity to bring about far -reaching structural changes in mental health policy and service provision, shifting the locus of care from psychiatric hospitals to the community. This article reports results of a case study assessing factors that hindered or promoted the planned reform. It focuses on the stakeholders, major issues, the process of negotiation and its results. It discusses the findings in light of the conflicting interests between and within the organizations involved, as well as the larger social and political context.
The theoretical and conceptual framework of the study was derived from public policy theories and in particular those related to public agenda and agenda-setting processes. The study was also informed by organizational and interorganizational theories and exchange theory.