OBJECTIVES: To explore major stakeholders' incentives and disincentives to adopt a financial risk-sharing mechanism regarding budget-impact estimates of adopting new technologies in the Israeli National List of Health Services (NLHS). According to the proposed scheme, HMOs will be partially compensated by the pharmaceutical and medical device industry if actual use of a technology is substantially higher than what was projected and allocated. On the other hand, HMOs will partially refund the government for budgets allocated to specific technologies that were not fully used. These unused budgets will be used for adopting other technologies in subsequent years. METHODS: Using a semi-structured protocol, we interviewed major stakeholders involved in the process of updating the NLHS (N=31). Interviewees included government officials, senior managers in the country's four HMOs, pharmaceutical industry executives, and health economists. We inquired into the interviewee's view towards our proposed risk-sharing mechanism, and their opinion on the other stakeholders' incentives to accept or object the proposed scheme. RESULTS: Our interviews revealed a wide range of incentives, disincentives, and barriers for adopting the risk-sharing mechanism. There was no consensus on what would be the different stakeholders' incentives and disincentives for adopting the proposed mechanism, even within the various stakeholders groups themselves. Most interviewees from the HMOs and the pharmaceutical industry supported the proposed risk-sharing agreement. Among government officials, the Ministry of Finance decision-makers tended to object to the proposed mechanism, while Ministry of Health executives usually supported the scheme, but believed that the pharmaceutical industry will not support this risk-sharing agreement. CONCLUSIONS: Since the success of implementing a risk-sharing mechanism depends mainly on its perception as a win-win situation for all stakeholders, we recommend that decision-makers consider the different incentives and disincentives exposed in our interviews, when implementing such a mechanism.