The chapter on healthcare in the Taub Center’s State of the Nation Report 2023 presents a status report on the health and the healthcare system in Israel prior to the war, and shows some of the challenges and problems facing the system, and attempts to deal with these issues. The chronic shortage in the healthcare workforce is worsening and the number of hospital beds per population continues to be low. On the other hand, there is a marked decline in infant mortality and a rise in the number of new licenses issuted in the healthcare field. Taub Center researchers, Prof. Nadav Davidovitch, Natan Lev, and Dr. Baruch Levi show that Israel returned relatively quickly to the familiar, pre-pandemic old normal, characterized by a low rate of public expenditure on healthcare. However, Israel needs to adjust to the post-crisis new normal, which remains valid in the current reality of the war, while continuing to plan for the long term in order to optimally deal with the old and new challenges it faces.
Israel is ranked in the lower third of the OECD countries with respect to national healthcare expenditure
In 2022, the national expenditure on healthcare in current prices was NIS 132.6 billion. In fixed terms, this is an increase of 0.8% relative to 2021, although per capita expenditure decreased by 1.1%. The expenditure in 2022 was 7.3% of GDP, as compared to the OECD average of 9.3% and the US expenditure of 16.6%. This figure puts Israel in the bottom third of the OECD countries. Israel also ranks low in terms of public expenditure on healthcare out of national expenditure, with only Portugal, South Korea, and Chile ranking lower.
With respect to sources of financing, in 2022, about 23% of national expenditure on healthcare was financed by a health tax and another 42% was financed from the State budget. Total private financing accounted for about 34%, of which almost one-quarter was direct payments by households for medications and medical services.
The number of new medical licenses is rising, as well as certification in healthcare professions; the number of nurses is also increasing following a prolonged downward trend since the 1990s
The per capita rate of physicians in Israel is lower than the OECD average, although in the past decade it has risen slightly from 3 to 3.3 physicians per 1,000 population, and is nearing its level in 2000.
The rate of graduates from foreign medical schools is higher in Israel than in any other OECD country and is close to 60%. Nonetheless, there has been a decline in their number over the past decade, primarily following the Yatziv Reform, which reduced the list of foreign medical schools that are recognized in Israel.
In 2021, 2,024 new medical licenses were issued, which is 2.8 times the number issued in 2010. Of these, 776 were issued to graduates of medical schools in Israel, which is 2.2 times the number issued in 2010. However, this increase is insufficient. In 2025, the number of students ready to start internships is expected to drop by 30%, and together with the growth in the population and in needs alongside the aging of medical staff, the crisis in the medical workforce in the healthcare system is likely to become even more severe. The researchers emphasize that in the past few years, the Ministry of Health has invested a good deal of effort in attempts to solve, or at least minimize, the workforce crisis.
The number of hospital beds in Israel is significantly lower than the OECD average, in particular in the periphery. The Ministry of Health has produced a plan to improve the situation
In 2022, the rate of general hospital beds in Israel (excluding psychiatric hospitalization beds) was 1.77 per 1,000 population, which is slightly higher than in 2021, when it was 1.75. Although the number of beds has been on an upward trend over the years, it has declined in per capita terms. This trend is in line with international trends and the move towards community care rather than hospitalization; nevertheless, the number of hospital beds in Israel is still significantly lower than the OECD average (3.4 per 1,000 population in 2021). The low number of general hospital beds is especially pronounced in the periphery; in Tel Aviv and the Haifa districts, the number of per capita beds is the highest while in the North and South, they are the lowest.
According to the plan recently presented by the Ministry of Health, the number of beds is expected to grow by about 11% in coming years, but in view of the rate of population growth and the aging of the population, the per capita rate in Israel will remain lower than in the OECD countries. Apart from the low number of general hospital beds, there is also an unequal geographical distribution. Thus, the per capita number of beds is highest in Tel Aviv and Haifa while it is lowest in the South.
On December 27, 2023, the Ministry of Health published its plan to expand hospital beds in the coming years, including an additional 1,790 general hospitalization beds, 300 rehabilitation beds, and 245 beds for psychiatric hospitalization. This plan has been modified to meet the needs of the war, with an emphasis on mental health and rehabilitation needs. In 2028, with completion of the plan’s implementation, the number of beds per 1,000 population will be 1.77.
The health status of the Israeli population: Life expectancy is higher for women than for men; the mortality rate is high in Yeruham and Dimona; and there has been a substantial decline in infant mortality
Life expectancy at birth is high in Israel relative to the OECD countries, and according to 2022 data, Israel is ranked seventh in the OECD with an average life expectancy of 82.9 years. Rates for 2023 are expected to continue to rise, with the slowing down of the COVID virus. The research shows that life expectancy for women is higher than for men – 84.9 years versus 80.9 years.
There are also disparities in life expectancy between population groups: the life expectancy of Arab men is the lowest while that of Jewish women is the highest. Education also has an effect on life expectancy and the gap benefiting individuals with a post-secondary or academic education is 6.2 years for women and 6.1 years for men.
There are also large disparities in mortality across districts and population groups. The highest rates of mortality are observed primarily in localities with a low socioeconomic level and in the periphery. In a breakdown by population group, high rates of mortality were found primarily in Arab localities, although also in Yeruham and Dimona. In contrast, low rates of mortality were found in a diversity of cities, most of which are located in the Center.
Another measure of health characterized by disparities is infant mortality. In general, Israel has a low infant mortality rate relative to the OECD countries. Over the years, there has been a significant decline in infant mortality in both the Arab and Jewish sectors; however, there is still a substantial disparity between the two sectors. In 2020, there were 1.6 deaths per 1,000 live births in the Jewish sector as opposed to 4.7 in the Arab sector. There are also disparities on a geographical basis: the rate of infant mortality is highest in the southern region, in particular among the Arab population, while the lowest rates are to be found in the Center and Tel Aviv.
Individuals refrain from medical consultations due to long waiting times
An examination by the Taub Center researchers of waiting times for medical consultation services shows that on average they range from 31 to 83 days. Similarly, large disparities were also seen by region, demographics, and health status. The longest waiting times were reported in the Center, Tel Aviv, and the South while the shortest were reported in the North. Jews and others reported longer waiting times than Arabs while the chronically ill, who consume more medical consultation services than the rest of the population, wait longer than individuals who are generally in good health. The study reveals that long waiting times are the main reason that individuals refrain from getting medical treatment: 35% choose not to get medical treatment for this reason. Other reasons are distance (19%) and cost (12%).
An examination of the expenditure of the health funds on complementary healthcare services (Shaban) in 2019–2020 shows very large differences between their expenditure on Jewish and non-Jewish populations. The Jewish population is characterized by a high proportion of members who buy complementary insurance: in 2020, at least 76% of the Jewish population held complementary insurance, while only 46% of the non-Jewish population had purchased insurance.
The health funds also spent more on complementary insurance for the population in Jewish cities. In 2019–2020, the cost per beneficiary in complementary insurance was 2.3 times higher in a Jewish city than in a non-Jewish one. The disparity in average annual medical expenditure per beneficiary between Jewish and other cities ranged from NIS 257 to NIS 361. Similarly, it appears that there are more complementary insurance beneficiaries outside the periphery, and the disparities are especially pronounced Leumit and Meuhedet health funds.
The new strains of COVID-19 are more infectious; vaccinations are still effective
Following a continuous decline in the number of serious cases of the coronavirus since the beginning of the year, their number has grown about three-fold since June. There has been a notable increase of new and more infectious variants in other countries, including the US. Nonetheless, they are similar in their clinical severity to the previous Omicron strains.
The highest rate of hospitalization due to COVID is found among the 60+ age group, with a peak in the 80+ age group. The data on seriously ill patients and the number of deaths paint a similar picture, with a peak in the 80–89 age group. An examination by vaccination status shows the highest mortality among the non-vaccinated, which appears to indicate that the vaccination is still effective in preventing severe morbidity and death.
Prof. Nadav Davidovitch summarizes: “The need to strengthen the public healthcare system, as discussed in several position papers published by the Taub Center, still exists, as does the need for planning of the healthcare system’s most important resource — its workforce. Although we live in an era of the new normal, it is still enmeshed in the old normal and in the system’s chronic issues. The challenges that exist — the aging of the population, disparities in health, and the strengthening of the workforce — call for the attention of the administration and placing the healthcare system high up on the national agenda.”
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.
For details, or to arrange an interview, please contact Nir Kaidar, Taub Center Executive Director: 050-6242474.