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 clinic-based care more or less directly, while the other funds used a combination of dialogue and financial incentives to persuade independent operators to move to clinic-based systems. The economies of scale in clinic-based services have, for instance, facilitated round-the-clock accessibility and capacities for supporting patients with chronic diseases.