In Search of Universality, Equity, Comprehensivenessand Competition: Health Care Reform and ManagedCompetition in Israel

Israel\u27s ongoing health reform provides lessons regarding attempts to combine universal coverage under national health insurance with a version of managed competition. Based on principles of \u27justice, equality and mutual aid, Israel\u27s National Health Insurance Law, 1994 guarantees access to a broad basket of basic services to be provided by four competing sick funds, and the availability of resources adequate to finance the basket. The new rights of citizens to universal coverage and to move freely among sick funds constituted a major policy breakthrough. However, successive amendments to the Law reflect continuing controversy over the amount of resources required to finance the basic basket. Despite the intention to base the system on decentralization and competition, successive amendments have placed more control over health system finance and sick fund management in the hands of the Ministries of Finance and Health. Updating the basic basket to take account of new technologies and drugs has raised unresolved dilemmas. In the Israeli case the dialectic of management vs. competition and of government vs. market, obscures fundamental issues related to the right of citizens to health services. The process set in motion by adoption of The National Health Insurance Law, 1994 calls on public managers and politicians to design institutions which can set priorities within a limited budget and effectively regulate the health care system

Feature discrimination learning transfers to noisy displays in complex stimuli

Introduction: Perception under noisy conditions requires not only feature identification but also a process whereby target features are selected and noise is filtered out (e.g., when identifying an animal hiding in the savannah). Interestingly, previous perceptual learning studies demonstrated the utility of training feature representation (without noise) for improving discrimination under noisy conditions. Furthermore, learning to filter out noise also appears to transfer to other perceptual task under similar noisy conditions. However, such learning transfer effects were thus far demonstrated predominantly in simple stimuli. Here we sought to explore whether similar learning transfer can be observed with complex real-world stimuli.Methods: We assessed the feature-to-noise transfer effect by using complex stimuli of human faces. We first examined participants' performance on a face-noise task following either training in the same task, or in a different face-feature task. Second, we assessed the transfer effect across different noise tasks defined by stimulus complexity, simple stimuli (Gabor) and complex stimuli (faces).Results: We found a clear learning transfer effect in the face-noise task following learning of face features. In contrast, we did not find transfer effect across the different noise tasks (from Gabor-noise to face-noise).Conclusion: These results extend previous findings regarding transfer of feature learning to noisy conditions using real-life stimuli

The left intraparietal sulcus modulates the selection of low salient stimuli

Neuropsychological and functional imaging studies have suggested a general right hemisphere advantage for processing global visual information and a left hemisphere advantage for processing local information. In contrast, a recent transcranial magnetic stimulation study [Mevorach, C., Humphreys, G. W., & Shalev, L. Opposite biases in salience-based selection for the left and right posterior parietal cortex. Nature Neuroscience, 9, 740-742, 2006b] demonstrated that functional lateralization of selection in the parietal cortices on the basis of the relative salience of stimuli might provide an alternative explanation for previous results. In the present study, we applied a whole-brain analysis of the functional magnetic resonance signal when participants responded to either the local or the global levels of hierarchical figures. The task (respond to local or global) was crossed with the saliency of the target level (local salient, global salient) to provide, for the first time, a direct contrast between brain activation related to the stimulus level and that related to relative saliency. We found evidence for lateralization of salience-based selection but not for selection based on the level of processing. Activation along the left intraparietal sulcus (IPS) was found when a low saliency stimulus had to be selected irrespective of its level. A control task showed that this was not simply an effect of task difficulty. The data suggest a specific role for regions along the left IPS in salience-based selection, supporting the argument that previous reports of lateralized responses to local and global stimuli were contaminated by effects of saliency

Reflexive and preparatory selection and suppression of salient information in the right and left posterior parietal cortex

Attentional cues can trigger activity in the parietal cortex in anticipation of visual displays, and this activity may, in turn, induce changes in other areas of the visual cortex, hence, implementing attentional selection. In a recent TMS study [Mevorach, C., Humphreys, G. W., & Shalev, L. Opposite biases in salience-based selection for the left and right posterior parietal cortex. Nature Neuroscience, 9, 740-742, 2006b], it was shown that the posterior parietal cortex (PPC) can utilize the relative saliency (a nonspatial property) of a target and a distractor to bias visual selection. Furthermore, selection was lateralized so that the right PPC is engaged when salient information must be selected and the left PPC when the salient information must be ignored. However, it is not clear how the PPC implements these complementary forms of selection. Here we used on-line triple-pulse TMS over the right or left PPC prior to or after the onset of global/local displays. When delivered after the onset of the display, TMS to the right PPC disrupted the selection of the more salient aspect of the hierarchical letter. In contrast, left PPC TMS delivered prior to the onset of the stimulus disrupted responses to the lower saliency stimulus. These findings suggest that selection and suppression of saliency, rather than being "two sides of the same coin," are fundamentally different processes. Selection of saliency seems to operate reflexively, whereas suppression of saliency relies on a preparatory phase that "sets up" the system in order to effectively ignore saliency