Reorganization of secondary medical care in the Israeli Defense Forces Medical Corps: A cost-effect analysis.

ABSTRACT Objective: To increase accessibility and availability of secondary medical care, 10 secondary unit specialist clinics were established side-by-side with five existing regional specialist centers, thus achieving decentralization. The purpose was to analyze the impact of this reorganization on overall consumption of secondary medical care and expenditures. Methods: Consumption of secondary medical care was analyzed by using computerized clinic and Medical Corps databases. Functional efficiency and budgetary expenditures were evaluated in four representative unit specialist clinics. Results: The reorganization resulted in an 8% increase in total secondary care consumption over 2.5 years. The establishment of unit specialist clinics did not achieve increased accessibility or availability for military personnel. Functional analysis of representative unit specialist clinics showed diversity in efficiency, differences in physicians' performance, and excess expenditures. Conclusion: The decentralizing re...