February 4, 2025 – A new study has taken a closer look at how healthcare quality is measured in three major countries—Israel, the United States, and the United Kingdom—uncovering striking similarities and critical gaps. The findings, published in the Journal of General Internal Medicine, highlight key differences and similarities in how healthcare systems prioritize quality measures, providing critical insights for future policy development.

The study evaluated three major sets of quality indicators: Israel’s Quality Indicators for Community Healthcare (QICH), the U.S.’s Healthcare Effectiveness Data and Information Set (HEDIS), and the UK’s Quality and Outcomes Framework (QOF).

The key findings of the study highlight several important aspects.

First, all three measures put heavy emphasis on family medicine and primary care, which account for the majority of the indicators. This emphasis may inadvertently overlook the contributions of other medical disciplines, such as mental health, surgery, and internal medicine.

Second, the study revealed an overwhelming reliance on process measures across the three systems, with limited emphasis on structural and definitive outcome measures. For instance, while QICH emphasized intermediate outcomes, it lacked indicators for structural measures and completely omitted definitive patient outcomes.

Third, the domains of “effective clinical care,” “community/population health,” and “communication and care coordination” received the most attention across all three systems. However, certain domains, such as “efficiency and cost reduction” and “patient safety,” were underrepresented, particularly in QICH and QOF.

Lastly, the study attributes differences in indicator selection to systemic and procedural disparities. While QICH operates through a voluntary, collaborative framework with Israel’s

HMOs, both HEDIS and QOF, are guided by external agencies that rely on financial incentives to drive compliance.

The study was led by Prof. Adam J. Rose from the Hebrew University’s Braun School of Public Health and Community Medicine, together with Reut Israeli from the Hebrew University’s Braun School of Public Health and Community Medicine and Dr. Gil A. Geva from Tel Hashomer Hospital.

Dr. Rose emphasized the need for greater balance in quality measurement systems, particularly in addressing underrepresented medical disciplines and quality domains. “Reassessing these indicators regularly could help ensure they better reflect the comprehensive needs of healthcare systems and the populations they serve,” he said.

The study serves as a foundation for future research to refine and expand quality measurement frameworks, enabling healthcare systems to promote more equitable and effective care.

The research paper titled “Evaluating and Comparing the Content Coverage of Quality Measure Sets from Israel, the United States, and the United Kingdom” is now available in the Journal of General Internal Medicine and can be accessed here.