In 1999 Israel began to implement a system for monitoring quality of care in its health plans. That system was based largely on a similar system in the United States that, until recently, was associated with steady improvements in performance. However, in recent years health plan quality in the United States appears to have reached a plateau. In contrast, health plans in Israel have continued to show improvements on many of the same measures. Between 2005 and 2007 they achieved a gain of 6.7 percent in nine measures of primary care quality, while US performance on these measures declined. These gains were achieved, in part, through intense cooperation among health plans and physicians. Israel is a much smaller country and differs greatly from the United States in how it finances health care. Nonetheless, we suggest that the Israeli experience could help the United States accelerate the move toward quality improvement-for example, through increased coordination among US employers, health plans, physicians, and physician groups.A s the United States considers various approaches to system-level quality improvement under the auspices of the Affordable Care Act of 2010 and other initiatives, the country might learn from the experiences of others. During the past decade Israel embarked on a nationwide effort to improve the quality of health care, with a particular emphasis on the primary care setting. Like their US counterparts, Israeli health plans play an important role in health care delivery. In addition, health care in both the United States and Israel is based on a mix of public and private elements, and both health systems rely on a mix of competition and regulation to influence quality and costs.
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