An autonomous primary care clinic within a health maintenance organization

The health system in Israel, as elsewhere in the world, is facing crises of organization and economics. Israel's largest HMO, which insures some 70% of the population, is a highly centralized body that makes policy decisions without consulting the community-based primary care teams. We describe the process of extending autonomy to a primary care clinic with the object of lowering costs and allowing its staff to prioritize the problems of the patient population and the community they serve.