in other countries the latter is often a key sticking point in reform particularly where there is rural depopulation and when local authorities own hospitals clalit as direct operator of primary care services shifted towards more clinicbased care more or less directly while the other funds used a combination of dialogue and financial incentives to persuade independent operators to move to clinicbased systems the economies of scale in clinicbased services have for instance facilitated roundtheclock accessibility and capacities for supporting patients with chronic diseases