To read the press release in Arabic, click here.
The healthcare chapter of the State of the Nation Report 2024 presents trends in national health expenditure and highlights several challenges facing the healthcare system, among them, the workforce crisis, a shortage of hospital beds and medical equipment, and long waiting times for specialist care. Alongside these challenges, the chapter’s authors, Prof. Nadav Davidovitch and Natan Lev, analyze the state of the healthcare system in light of the October 7, 2023 War. They emphasize that, despite the severe blow the system suffered, it demonstrated resilience and functioned at an extremely high level. However, they warn that the erosion of budgets and workforce capacity raise significant concerns about the system’s ability to continue bearing the heavy burden placed upon it, both during normal times and in times of war, as well as rehabilitation activities that will be required once the conflict ends.
A decline in national expenditure alongside increasing reliance on private funding
In 2023, national health expenditure in current prices totaled NIS 136.3 billion, amounting to 7.2% of GDP. In constant prices, this expenditure decreased by 0.9% compared to 2022, with per capita expenditure dropping by 3%. While private funding as a percentage of GDP remained stable at 2.5%, its share of national health expenditure rose — from 33.9% in 2022 to 34.8% in 2023.
In an international comparison, Israel’s per capita current health expenditure in terms of purchasing power parity was lower than that of most OECD countries in 2023, amounting to $3,803.
Israel ranks relatively low among OECD countries in the share of public health expenditure (including health tax) as part of total current national health expenditure. Only South Korea, Portugal, Greece, Chile, and Mexico rank lower.
Medical workforce is growing, but remains below the OECD average
The number of active physicians and nurses per 1,000 population — standing at 3.47 and 5.04, respectively — remains below the OECD average. According to projections, the shortage of physicians is expected to worsen further: by 2035, the number of physicians per 1,000 population is projected to decline to 3.02, despite the anticipated increase in the number of professionals entering the field.
Long waiting times for specialist care, especially in critical fields like neurology and endocrinology
The research shows that between 2023 and 2024, there was a slight decrease in waiting times for most specialties. However, in dermatology, waiting times continued to increase — from approximately 35 days in the first quarter of 2023 to about 37 days in the first quarter of 2024. The fields with the longest waiting times were endocrinology and neurology (around 50 days), compared to orthopedics and gynecology, which recorded the shortest waiting times (approximately 20 days).
Young adults aged 20 and over are exercising more, but smoking remains prevalent in this population
The study, which also examines lifestyle and risk behaviors, shows that more than half of individuals aged 20 and over engage in regular physical activity and, as expected, demonstrate higher quality-of-life indicators. The data further reveals that individuals with normal body weight engage in physical activity more frequently than those with abnormal weight.
In terms of smoking as a behavioral risk factor, the study indicates that between 2019 and 2022, smoking rates among individuals aged 16–74 increased by 1.6%. Among men, the primary increase was observed in the lowest socioeconomic tier. Among women, the highest smoking rates were found in the middle-to-upper socioeconomic tier. Additional findings show that 25% of the population over age 20 are smokers, and approximately 25% are frequently exposed to passive smoking in their environment.
The health costs of the War: Psychological trauma, health deterioration, and heavy economic burdens
One year after the start of the war, over 70,000 individuals have been recognized as victims of hostile actions, and nearly 13,000 have filed for permanent disability benefits, the vast majority due to psychological issues. This has come at a heavy economic cost: more than NIS 370 million was paid to individuals with a recognized disability, over NIS 250 million was spent on rehabilitation, and more than NIS 1.2 billion was spent on medical care. In addition, there has been a decline in the health status of populations particularly affected by the war. A survey conducted among Maccabi Health Fund members revealed that approximately 80% of relatives of hostages reported a worsening self-perception of their health status, with significant weight loss and increased use of antidepressants and sleeping medications. Evacuees also reported deteriorating health conditions, with about 30% of evacuated women reporting poor physical health and 60% reporting psychological harm, compared to 20% and 50% in the general population, respectively.
Populations living in conflict areas have also suffered significant harm. A study conducted among Clalit Health Fund members reported a 200% increase in the use of anti-anxiety medications among residents of the Gaza border region, compared to a 50% increase in the general population. Among security personnel, from the start of the war until October 7, 2024, 726 soldiers were killed, and 4,576 were hospitalized due to military incidents. Additionally, approximately 15,000 soldiers were classified as suffering from stress-induced trauma following exposure to traumatic events, 18% of whom were removed from combat. Since the start of the war, approximately 1,000 new patients have been admitted each month to the Rehabilitation Department of the Ministry of Defense, most of them reservists. By the end of 2024, their number is expected to reach 20,000, with about 40% suffering from psychological symptoms.
The war has had a significant impact on public health, including a decline in vaccination rates and an increase in outbreaks of infectious diseases. A notable emergency is the outbreak of the polio virus in the Gaza Strip, following the war’s negative affect on hygiene conditions and vaccine accessibility in the area. Beyond the immediate risk to Gaza residents, this outbreak poses a threat to Israeli citizens and necessitates strengthening regional cooperation for vaccination campaigns and clinical and epidemiological monitoring.
Prof. Nadav Davidovitch, co-author of the study, stated: “Since the outbreak of the war, the healthcare system has been grappling with substantial challenges, foremost among them the need to simultaneously address routine needs and those arising from the emergency situation. It is important to remember that this is a system that entered the war with diminished budgets and a severe shortage of personnel and resources. Despite all this complexity, the healthcare system demonstrated impressive resilience and an exceptional ability to respond to the required needs. However, without a shift in national priorities, the system will struggle to sustain its functionality over time. Long-term strategic planning to invest in the public healthcare system is needed, which should include strengthening mental health and rehabilitation services, increasing investment in medical personnel, and improving access to healthcare services for the entire population.”
The Taub Center for Social Policy Studies in Israel is an independent, non-partisan socioeconomic research institute. The Center provides decision makers and the public with research and findings on some of the most critical issues facing Israel in the areas of education, health, welfare, labor markets and economic policy in order to impact the decision-making process in Israel and to advance the well-being of all Israelis.
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