The Taub Center State of the Nation Report 2022, part of the Herbert M. Singer Annual Report Series, presents new data and deep analyses from the past year in the areas of the economy, labor market, welfare, health, education, and demography, as well as three new studies: Recent Trends in Marriage and Divorce in Israel, The COVID-19 Pandemic: The Case Fatality Rate, and The Marriage Premium in the Israeli Labor Market.
One new study shows that there is a decline in the marriage rate in the Jewish population, alongside a rise in the divorce rate in the Muslim population. The study on the COVID-19 epidemic brings to light surprising evidence that countries that have had women in the highest government office at some point since the turn of the century fared better during the pandemic and had lower mortality rates than other countries. The third new study shows that married individuals have a higher chance of being employed and benefit from higher salaries than do their single counterparts.
In terms of the education system, there are encouraging findings that show that the system is in better shape than is generally believed. The research shows that, for instance, the number of mathematics teachers in the middle schools between 2010 and 2021 rose by 47%, and in the remaining sciences by 34%. In addition, the resources devoted today to the education system in Israel are significantly greater than those a decade ago.
In the welfare system there have been substantial changes in policy and in the assistance available to senior citizens and persons with disabilities. The research on macroeconomic trends in Israel shows a picture of declining unemployment and rising numbers of job vacancies. The research focuses on the high tech sector among others where the number of work hours has risen since 2004 by about 20% and production has increased accordingly by about 170%. The research on the Israeli labor market also addresses the high tech sector, among other topics, and points to a striking increase in the number of positions and wages in the sector – a finding that reinforces the claim that the labor market experienced an exceptional recovery from the COVID-19 crisis.
In the health system the picture is somewhat less bright. The study indicates that the incidence of diabetes is on the rise in the population. With this, Israel’s high life expectancy rate places it at the top of the ranking among OECD countries. In addition to these findings, demographic trends for Israel are presented that show that due to the rapid growth rate of Israel’s population, it will reach 9.65 million people by the end of the year.
The book’s editor is Prof. Avi Weiss, President of the Taub Center for Social Policy Studies in Israel and professor of economics at Bar-Ilan University.
MACROECONOMIC TRENDS IN ISRAEL: AN OVERVIEW (in Hebrew)
Prof. Benjamin Bental, Dr. Labib Shami
Prof. Benjamin Bental and Dr. Labib Shami from the Taub Center present an optimistic picture of the Israeli economy, which has stabilized and returned to its pre-pandemic state. At the same time, the research points to structural problems that are hindering labor productivity and examines the cost of living in Israel relative to other countries.
Less unemployment and more job vacancies
During the initial months of 2020, and with the spread of the COVID-19 pandemic, the rate of unemployment in Israel increased while the rate of job vacancies remained unchanged. When the rate of unemployment began to stabilize at a higher rate, the number of job vacancies began to rise significantly. However, in mid-2021 there was no change in job vacancies even though unemployment began to return to its pre-pandemic level. The rate of job vacancies relative to the rate of unemployment remains high relative to the pre-pandemic period.
Workhours are longer in Israel and labor productivity is lower, except in the high tech sector
Relative to European countries whose population sizes are similar to Israel’s (Austria, Ireland, Belgium, Denmark, Finland, the Netherlands, Sweden, and Switzerland), Israeli workers spend more time at work. In 2019, Israelis worked an average of 1,900 hours a year while in most other countries, the average was about one-quarter less than that.
In terms of productivity, Israel is doing less well than these countries: in 2021, labor productivity in Israel was about $48 per workhour (in 2017 prices), while in the reference countries it was higher by about one-quarter.
In contrast, Ireland, whose number of work hours is similar to Israel’s, has seen an impressive jump in labor productivity. In 1995, it was higher than Israel’s by 40% while today it is more than 160% higher. One of the explanations for the gap is the low levels of public capital per capita and private capital per capita in Israel, which have not grown since 1980 and which remain very low relative to the reference countries.
The high tech sector
In 2021, the high tech sector in Israel employed about 10% of the workers in the economy and contributed about 15% of GDP. A bit more than two-thirds of high tech jobs are in services and the rest in manufacturing. In the service industries, particularly notable is the rapid growth in the number of programmers and the decline in the number of jobs in information services. The number of work hours in high tech manufacturing has risen by about 20% since 2004 while its output has grown by about 170%.
The large gap in food and energy prices between Israel, and Europe and the US
The Taub Center study indicates that the increase in prices is much lower in Israel than in the US and the Euro area. Thus, while food prices in the US and Europe rose faster than the CPI, in Israel they rose almost identically. The gaps in energy prices between Israel and the reference countries is even larger: in the US and Europe energy prices rose by about 40% while in Israel they rose by half that rate.
The cost of living primarily harms the poor
The Taub Center researchers point to the large variation in consumption patterns between different income groups. For example, households in the top quintile (in which income per capita is the highest) spend relatively more on average on home maintenance, healthcare, transportation, and communication than those in the lower quintiles. The differences in consumption patterns create differences in the effect of inflation on the various income quintiles. The housing component of the CPI rose at a higher rate for the top quintile than for the bottom quintile. In contrast, the situation was the opposite for furniture and home appliances: households in the bottom quintile spend 3.6 times more than households in the top quintile on the repair of kitchen appliances and 30% more on disposable plates, cups, and cutlery, which became much more expensive as a result of the imposition of a tax on these items.
A comparison of expenditures in July 2022 with the average in 2020, shows that the expenditure of households in the top quintile rose by 8%, that of the middle quintile by 7% and that of the bottom quintile by 6.4%.
The optimistic forecast for the debt-to-GDP ratio
In 2020, governments adopted measures to mitigate the effect of the pandemic and they increased their deficits and their debt levels significantly. As a result, Israel’s debt-to-GDP ratio rose at a similar rate to that of the OECD average, namely about 12 percentage points. In the Euro area, the average increase was even larger — about 14 percentage points.
In Israel, the Ministry of Finance’s forecast for the deficit — made at the time when the 2021–2022 budget was passed — was 6.7% of GDP for 2021 and 3.9% for 2022. The actual deficit for 2021 was 4.6% of GDP while during the first three quarters of 2022, there was a budget surplus of 2.6% of GDP. These figures had a dramatic effect on the debt-to-GDP ratio.
According to the latest forecasts, the IMF expects that by the end of 2022 the debt-to-GDP ratio in Israel will be 61.5%, which is very close to its pre-pandemic level, and that it will continue to decline to about 55% toward the end of the decade. This will place Israel’s ratio at a similar level to that of the median of the OECD countries.
Prof. Benjamin Bental, one of the study’s authors, stated that “the Israeli economy, like others worldwide, has undergone an upheaval as a result of the pandemic. Nonetheless, Israel’s economy and those of other developed countries have recovered at a surprising pace and have almost eliminated the gap in GDP that resulted from the pandemic. With this, it is important to stress that we should not ignore the basic problems that underlie our economy. Despite the success of the high tech sector, the gap between Israel’s labor productivity and that of other developed countries remains very large. In order to solve this problem, we need to eliminate the distortion in the incentives faced by the private sector and to significantly raise public investment.”
THE LABOR MARKET IN ISRAEL: AN OVERVIEW (in Hebrew)
Michael Debowy, Prof. Gil Epstein, Prof. Avi Weiss
Taub Center researchers Michael Debowy, Prof. Gil Epstein, and Prof. Avi Weiss looked at the Israeli labor market following the shocks it experienced during the COVID-19 pandemic. The research surveys the trends in employment and wages in the various sectors of the economy and among the various segments of the population, the investment in workers’ human capital as revealed by the state of higher education and vocational training, and forecasts for Israel’s labor market.
Employment in Israel and the recovery during 2022
In 2022, the unemployment rate fell dramatically – to less than 3.5% in the spring, one of the lowest rates in the history of the Israeli economy. It then rose somewhat at the end of the summer (reaching 4.3% in October). Even if workers who were on furlough from their work due to the pandemic are included among the unemployed, the unemployment rate during the first half of the year fell to less than its 2019 level and during the second half of the year it did not exceed the level at the end of 2019 by more than half a percentage point.
In 2020–2021, there was a significant decline in employement relative to 2019 across almost all the industries; however, in 2022 it returned to its previous level in most industries. In some industries, the number of jobs increased significantly relative to the pre-pandemic level. Particularly noticeable are the health, social welfare, and nursing care industry (112,000 more jobs than in 2019) as well as the high tech sector (60,000). The construction industry — which was severely impacted by the pandemic — also experienced a recovery and an increase of about 17,800 jobs, which supported, among other things, a recovery in employment among Arab men. However, some industries remained smaller than they were in 2019 with respect to level of employment. The most prominent is management and support services (33,000 fewer jobs than in 2019) and accommodation and food services (12,100).
The extent of recovery varied across segments of the population. A comparison by gender shows that while the rate of employment among men in the summer of 2022 was equal to that in the summer of 2019 (82%), among women, there was an increase of about 2 percentage points (77% vs 75%). Similarly, the rate of employment among women in general returned to its former level and even surpassed it. There was also an impressive recovery among Arab men. In contrast, the rate of employment remained lower than prior to the pandemic for Haredi (ultra-Orthodox) men.
Wage increases in the various industries but a decline in health and social welfare
In traditional manufacturing and construction, wages rose by 9%–11% between 2019 and 2022. In the information and communication industry and in the high tech sector, they rose by 18%–19%; in agriculture and in finance and insurance, they rose by 9%; and in the mining and quarrying industry, they rose by 13%.
There was a drop in the average wage of about 9% in the health and social welfare industry, in which the number of jobs surged during the pandemic. This was apparently because most of the jobs that were added paid less than the industry average.
A particularly large increase in the number of jobs and in wages in the high tech sector
In the high tech sector, which employs about 10% of the workers in the economy, not only did the number of employees increase during the pandemic and the recovery, but there was a surprising increase in wages (which were high from the start). The research shows that while wages outside of high tech grew by 4% following the pandemic, the average wage in the economy as a whole grew by about 7%, which implies that the wage increases in high tech were responsible for a large proportion of the increase in the average wage. The research also found that during most of the last decade, wage increases in high tech consistently led to wage increases in the rest of the economy. This finding supports the hypothesis that other industries are forced to raise wages in order to compete with high tech and to prevent the “flight” of their workers. Although there has recently been a lot of discussion of layoffs in high tech, so far there are no signs of a drop in the number of employees in the sector, as, apparently, in parallel to companies that are firing, there are also companies that are hiring.
The paper helps solve an identity mystery about the unusually large number of new higher students in higher education during the first year of the pandemic. In the 2020/2021 academic year there was a very large increase in the number of higher education students, which was caused essentially by the restrictions and lack of alternatives available to young adults that prevented them from traveling or working. What was not clear at the time was whether this was simply a temporal shift, with the increase reflecting young people who would have chosen to obtain a higher education in any case, but chose to start their education earlier because they had few alternatives during the shutdown, or indicated many who would not have chosen to get a higher education at all, but did so because of the lack of viable options. The data on the number of new students in the 2021/2022 academic year help us conclude that the latter is most probably the case – the growth seems to have come from young adults who would not have studied at all were it not for the pandemic.
Michael Debowy, one of the authors of the study, relates to the data as follows: “The labor market has recovered well from the pandemic. This is reflected by the growth in employment in all segments of the population and in particular among women whose rate of employment in 2022 surpassed their pre-pandemic levels. There were also wage increases in most industries and in particular in the high tech sector, which also continued to add jobs.” Nonetheless, Dubowy adds that “it is important to emphasize that despite the optimistic picture presented in the study with regard to the future of economy, the state must continue to invest in infrastructure, in access to higher education and vocational training for all segments of the population, and in the possibilities for high-quality employment for Israeli workers, with the goal of ensuring long-term growth.”
THE MARRIAGE PREMIUM IN THE ISRAELI LABOR MARKET (in Hebrew)
Michael Debowy, Prof. Gil Epstein, Prof. Avi Weiss
A study conducted by Taub Center researchers Michael Debowy, Prof. Gil Epstein, and Prof. Avi Weiss examines the link between marriage and salary level, and finds that, as in other developed countries, married employees benefit from a distinct and positive premium. Married employees earn higher salaries than unmarried employees. Even after controlling for various employee characteristics (such as age and education), significant differences were found between the married and single populations in Israel. Thus, married men and women received higher per hour salaries, but the premium’s magnitude depends on a range of characteristics such as sector, gender, and occupation. White collar employees, for example, enjoy a similar, if smaller than average, premium whereas blue collar employees, by contrast, enjoy a slightly larger than average premium, with men benefitting more than women.
Married? Your chances of finding work and earning more are greater
The study shows that the probability of a currently married man being employed is 10 percentage points higher than that of his unmarried peer. Men who were married in the past but currently are not married held an advantage of 3 percentage points as far as their probability of working, compared to their unmarried counterparts.
By contrast, currently married women show a probability of working at 2 percentage points lower than single women, whereas divorced, separated, or widowed women have a 2 percentage point higher probability of working than single women.
With regards to salary, the average hourly salary among married men is about 30% higher than that of their single peers (after controlling for other variables), but this advantage is completely erased when it comes to men who were previously married but currently are not. Among women, the marriage premium is lower: they earn about 20% more than single women with half of this advantage retained when they are no longer married.
Disparities in distribution by gender, origin, and sector
Among married men the probability of working is 10 percentage points higher than for unmarried men. In a breakdown by sector, the difference is 8–9 percentage points among Jews and almost 16 percentage points among non-Jews. Jewish non-Ashkenazi women are employed less, especially if their marriage has ended. By contrast, Ashkenazi women and non-Jewish women who are currently married or have been in the past do not show a higher likelihood of employment, and, among non-Jewish women, employment is even lower.
Jewish third generation men of mixed origin (Ashkenazi and Mizrahi) benefit from the highest premium, with salaries 36.5% higher than for single men, followed by Ashkenazi men and Mizrahi men, with premiums of some 25%–27%. Non-Jewish married men earn similarly to single men.
Among married women the premium is lower. Married Ashkenazi women receive a benefit of about 62% of the premium earned received by Ashkenazi men, whereas Jewish non-Ashkenazi women receive 84%–87% of the premium men of the same origin enjoy. Divorced, separated, and widowed Jewish non-Ashkenazi women receive the same premium as their married counterparts, whereas among Ashkenazi women the premium is received exclusively by currently married women. This is in contrast to men, where the divorced, separated, and widowed men do not earn more on average than single men.
Among non-Jewish women, for those who are currently married or were in the past, researchers found a negative premium: a salary that is lower by some 10% and 16% than that of single women, respectively. This is in addition to the negative link between current and past marriage and employment in this group.
“The marriage premium is a familiar phenomenon worldwide, with a variety of explanations. In this study we examined whether the premium seen in other countries exists to the same degree in Israel despite a very different demographic reality: in Israel the marriage rate is higher, the divorce rates are lower, and only about 8% of children are born outside of marriage. We found that despite these and other differences, the situation in Israel is not essentially different from that in other developed countries,” explains Prof. Avi Weiss, President of the Taub Center and one of the researchers.
ACHIEVEMENTS IN ISRAEL’S EDUCATION SYSTEM: AN OVERVIEW
Nachum Blass
Has Israel’s education system deteriorated? Nachum Blass, Principal Researcher and Chair, Taub Center Education Policy Program, addressed this question by examining various aspects of the education system between 2010 and 2020. He found that, despite the popular belief that the education system is in a dire state, many changes have been made for the better: the budget increases annually, students’ academic achievements are improving (although they have not reached those of their OECD peers), the number of students per teacher has dropped, the number of teaching hours has increased, teachers’ education levels have risen, and there is a better match between the subjects the teachers teach and the subjects for which they trained. The study was based on data from the Central Bureau of Statistics (CBS), the Ministry of Education, and RAMA (the National Authority for Educational Measurement and Evaluation).
Narrowing the gaps? Despite the improved academic achievements by Arab students and the increase in the education budget allocated to this sector, their achievements still do not reach those in the other sectors
Examining changes in the Ministry of Education budget between 2012 and 2020, it is clear that the greatest budgetary increase was directed towards Arab and Bedouin education. The increases in budgets for the Hebrew and Druze sectors were more moderate.
“This phenomenon admittedly presents an optimistic picture but does not reflect the disturbing reality of inequality in budgeting for schools serving students from similar socioeconomic backgrounds, particularly in high school. There is a minor improvement in the size of per student expenditure and in reducing the disparity between Jewish students and Arab students, but we still cannot state that such disparities have been eliminated. We are still a long way from reaching that,” said researcher Nachum Blass.
In examining the Meitzav exam (school efficiency and growth indicators) scores for students in Grade 8, the overall grade among Hebrew speakers showed the most significant increase. All sectors showed improvements in mathematics, but it was a little greater among Hebrew speakers. The overall score rose in English (as a second language) but the main improvement was among Arabic speakers. The most evident improvement was seen in sciences.
The portion of students receiving Bagrut (matriculation) certificates in high school out of all Grade 12 students rose from some 60% to about 70% between 2010 and 2019. Here, too, increases in the Arab sector are particularly noteworthy, with an increase from 50.1% to 69.4%.
The perception that the education system is deteriorating is unfounded
Between 2000 and 2019, the overall number of students in the education system grew by 49%. During that same period, the education system budget grew by 90% and the number of teaching hours by 115%. The number of teaching staff in the education system also grew in the past decade by an annual average of about 3.2%. In high schools, for example, the number of mathematics teachers grew by 47% between 2010 and 2021, and in other science subjects by 34%. This means that the resources currently available to the Israeli education system are far greater than those available a decade earlier.
An improved match between teachers’ training and the subject they teach, primarily in mathematics and English
The study examined the match between the subjects teachers’ trained in and the subjects they teach for language arts (Hebrew), mathematics, and English (as a second language) and found that in primary education, only 20% of teachers in the Hebrew State education system held appropriate qualifications; this had not changed over the past decade. In the Arab education sector, by contrast, teachers whose native language is Arabic receive separate training for teaching Hebrew, and, therefore, the portion of teachers whose educational training matches the subjects they teach is 60%.
In middle school and high school, the situation is better than in primary schools, but a clear trend of deterioration is discernible. Here, too, the situation in the Arab education system is better than in the Hebrew system. This may be due to the sharp drop in the number of students in humanities and social sciences, and the education system’s approach, which focuses more on math and English. Thus, there is an increasing match between teacher training and the subjects they teach in math and English over time, although there continue to be many teachers who did not train in accordance with Ministry of Education requirements.
Students testify to an improved school environment
The study compared between responses in 2009/2010 and 2019/2020 to questionnaires that were part of the Meitzav exams dealing with the school climate: relationships among students, relationships between students and teachers, the student’s feelings of personal safety, and more. The majority of student responses at all education levels indicate an improvement in their feelings towards the school, and only a very small number of students in high schools indicated no change.
Primary and middle schools showed greater improvement in the Arab sector than in the Hebrew sector, while in high school, some aspects showed greater improvement in the Arab sector and some in the Hebrew sector. A key point that must be addressed is complaints of verbal violence, and even physical violence, by teachers; In primary and middle school education there has been an improvement, but in high schools the situation has worsened.
ISRAEL’S SOCIAL WELFARE SYSTEM AFTER THE COVID-19 CRISIS:
AN OVERVIEW (in Hebrew)
Prof. John Gal, Shavit Madhala, Ori Oberman
The COVID-19 period saw Israel’s social expenditure reach a peak of more than 20% of GDP. In 2021, it was still larger than it was prior to the pandemic’s outbreak, but has since significantly dropped, especially in areas of social security and housing. Developments in social policy over the past year indicate progress in areas dealing with individuals with disabilities and senior citizens, but the growing tendency to reduce social expenditure generates concern over growth in poverty rates and inequality in Israeli society. Taub Center researchers Prof. John Gal, Shavit Madhala, and Ori Oberman caution that if this trend continues, the social welfare state will find it increasingly difficult to deal with the social hardships that characterized Israeli society prior to the COVID-19 pandemic
Reducing social expenditure increases poverty levels and deepens inequality
Israel’s 2021 social expenditure totaled NIS 297 billion, constituting 59% of the country’s budget (not including debt repayments). Expenditure on social security, which served as the main tool for dealing with the economic side of the COVID-19 crisis, lessened in 2021 by some NIS 10 billion compared to the previous year, whereas expenditure on health grew in 2020 by about NIS 21 billion and in 2021 by about NIS 2 billion. Expenditure on social welfare, which includes social services but not social benefits, lessened by some NIS 2 billion relative to the previous year. Expenditure on housing for 2021 dropped by some NIS 1 billion relative to 2020, totaling about NIS 4 billion.
Poverty and inequality in Israel are very high compared to other welfare states. Arab and Haredi (ultra-Orthodox Jewish) households are extremely vulnerable to the risk of poverty. Taub Center researchers found that families in these two constitute about 45% of the families living below the poverty line, which is almost double their portion in the overall population: Haredi families comprise some 7.4% of the total population but 12.7% of the families living in poverty, whereas Arab families constitute 32% of the population classified as poor, yet account for only 17.4% of Israel’s general population.
A relaxing of conditions for assistance to senior citizens and expanding the scope of assistance
The number of senior citizens entitled to nursing assistance has considerably increased in recent years: 176,000 in 2018; 197,000 in 2019; 240,000 in 2020; and some 273,000 in 2021. Midway through 2022 the number had already reached 301,000, representing an increase of 71% since 2018.
Taub Center researchers ascribe this increase in recipients of nursing allowances to changes created by reforms in the field of nursing insurance, including examination of most allowance claims based on medical documents and a personal interview, and payment of the allowance directly to the claimants rather than through service in-kind. The growth in the number of nursing allowance recipients reflects not only growth in the elderly population, say the researchers, it also reflects changes in policy and how senior citizens of impaired functioning are assisted.
Another significant change in the social security system in recent years is the increase in income supplements to recipients of a senior citizen pension and survivors’ pensions whose incomes are low. The study’s findings show that the sum of allowances paid in the first half of 2022 grew by almost 70% relative to the amount paid in the same period during the previous year. This growth does not derive from any significant change in the number of benefit recipients, but, rather, from an increase in the actual amount of the allowance.
Dramatic change in the law on welfare services for individuals with disabilities
Legislation of the Social Services Law for People with Disabilities indicates a dramatic change towards this population, say Taub Center researchers, defining it as “the most important legislation in the field of social services in 2022.” If fully implemented, this law is set to significantly reduce the number of individuals with disabilities living in facilities outside the community and greatly increase individual independent living through the provision of a personal budget and the freedom to choose community services suited to their needs, thus encouraging personal development and integration into the larger society.
Social workers are leaving the profession despite efforts to improve their status
The new collective agreement signed at the end of May 2022 was meant to promote changes in salaries of employees in the field of social work. The agreement includes an increase in starting salary to NIS 8,500 per month and an increase in the salaries of all social workers by 5%–20%. Another important clause in the agreement relates to increased salaries for social workers who are not filling managerial positions; wishing to ensure that their salaries also increase over the span of their careers, the agreement determines that the salary calculation will also give greater weight to components of specialization, education, and experience in a range of roles. The collective agreement’s expansion order, ensuring that social workers who are not government or local authority employees will also be included in the agreement, becomes effective in January 2023. Yet despite the agreement, it seems that many social workers continue leaving the profession, whether due to heavy workloads, an absence of personal security following violence by service users, or an erosion of the profession’s public status.
Data support the claim that certain parts of the social services system have improved with the passing of the COVID-19 crisis, notes Prof. John Gal, but other areas have fallen back into the old problematic patterns and it is unclear whether there is any willingness to adopt the necessary steps for coping with them more effectively than in the past.
THE HEALTHCARE SYSTEM IN ISRAEL: AN OVERVIEW (in Hebrew)
Prof. Nadav Davidovitch, Baruch Levi
The relatively rapid containment of the COVID-19 pandemic allowed the Ministry of Health to direct its efforts back to the burning issues previously on the health system’s agenda, that is, to plan policies and reorganize.
A Taub Center study conducted by researchers Dr. Baruch Levi and Prof. Nadav Davidovitch examined the status of the issues that require the attention of the healthcare system, including inequality in health and healthcare, the shortage of human capital, the nursing professions, and the relationship between public and private medicine.
Insufficient physicians and nurses, particularly in the geographic peripheries
Although the number of active physicians in Israel remained stable at 3.3 doctors per 1,000 population during 2020, this is still considerably lower than the OECD average of 3.6 per 1,000 population. The number of active nurses in Israel also remained stable, and in 2020 was 5.1 per 1,000 population, a very low figure compared to OECD countries where the average is 8.9 per 1,000 population.
For both doctors and nurses, the share of older professionals is relatively high: 49% of physicians active in Israel are aged 55 and up, the second highest in the OECD after Italy. The number of nursing staff in Israel over the age of 55 grew from 23% in 2000 to 39% in 2020, and the challenge of filling these positions in the coming years will grow.
“Israel is not exceptional with regard to the need to cope with the challenges of human resource shortages, disparities in accessibility to professionals, and lengthy waiting times for consultations and treatments. These problems are shared by so many countries that the WHO recommended adopting ten steps to improve the state of human resources in health systems. Among them are a better work-life balance, promoting leadership capabilities in health professions, and protecting the physical and mental health of health system employees,” Prof. Davidovitch explains.
The number of physicians per population in the Tel Aviv district is the highest, at 2.3 times more than in the Northern district, which has the lowest ratio. The Haifa region has the most nurses per population, 2.05 times higher than the number in the South, the area with the lowest ratio. Due to manpower shortages, which are particularly evident in the periphery, slots were made available this year for medical students in the North and South as part of the Ministry of Health’s “Ilanot” program, which aims to train physicians living in the periphery and encourage them to continue living and practicing in those locations.
“Disparities in professional manpower based on geography are evident not only with respect to doctors and nurses but also in numerous additional health professions such as dentists, pharmacists, speech therapists, opticians, occupational therapists, and physiotherapists. Generally, the numbers of such professionals in the Northern and Southern districts are extremely low relative to other districts,” Dr. Baruch Levi added.
Despite the drop in COVID-19 related hospitalizations, Israel is at the top when it comes to hospital occupancy rates
Regarding medical infrastructures such as MRI and CT devices and hospital beds, Israel is ranked low relative to other OECD countries. The rate of overall hospital bed occupancy in Israel is among the highest among the organization’s member countries. Only Canada’s rates are higher. In 2020, Israel’s average general hospitalization time was 4.6 days; only Turkey has shorter stays than Israel (4.5 days on average). This compares to 6.6 days on average in OECD countries. Thus, during intense hospitalization periods such as winter, typified by influenza, for example, occupancy in hospitals and the different wards fill-up unreasonably, which can pose an added danger to the health of hospitalized patients.
In additional to full occupancy, waiting times for various medical treatments in Israel are very long compared to those in the other developed countries. Waiting times for a dermatology consultation are particularly high at more than 30 days. For other professions, waiting times are around 15 to 20 days on average, and in some specialties there was even a slight increase during 2021 relative to 2019. In 2020, a drop in waiting times was noted in all fields, most likely due to the fall in demand for non-urgent health services during the COVID-19 pandemic. Waiting times also differ according to geographic location, and, in general, are particularly lengthy in the Negev.
Israel is at the top of OECD life expectancy ranking
Israeli women and men are at the top of the OECD life expectancy rankings. Life expectancy of women in Israel is higher than of men: 84.8 years compared to 80.6. Another measure in which Israel excels is in “healthy life expectancy” in which Israel is ranked sixth worldwide. With this, there are significant disparities between population sectors, geographic areas, and residential localities for the indices of life expectancy, infant mortality, and chronic morbidity, in addition to various risk factors such as smoking and obesity.
Since the start of COVID-19, existing smokers added an average of 13 cigarettes per day, whereas young people are smoking less
The percentage of adult smokers in Israel (age 21 and older) in 2020 was 20.1%, higher than the OECD average. Men smoke more than women: 25.6% compared to 14.8%. The number of Arabs who smoke is greater than the number of Jews: 24.4% versus 19.1%. Since COVID-19’s outbreak 26.8% of smokers smoke more: an addition of 13 cigarettes per day on average per smoker. Among young adults there is an evident trend towards a reduction in the reported numbers who have tried smoking cigarettes or hookahs.
Unlike the consumption of cigarettes, the consumption of alcohol in Israel is among the lowest in OECD countries, with a 2019 average of 3.1 liters per person aged 15 and up.
The incidence of diabetes is trending up
As of 2019, the incidence of diabetes in Israel’s population stood at 6.2% compared to an average of 5.5% in EU countries. Since 2000, there has been an increase in diabetes in Israel of about 94%, when the incidence was only 3.2% of the population. Among adults aged 20–79, about 8.5% have diabetes .
Prof. Nadav Davidovich explains that “the array of health indices presented by the research should set warning lights flashing among policy makers. It should be remembered that apart from indices of expenditure, a system’s functioning depends to a significant extent on its organizational methodology. The developments that have occurred to this point in 2022 should not be taken for granted – a series of initiatives led by the Ministry of Health aimed at resolving diverse issues, such as the long wok hours of medical residents and restraints on private health spending, so that access to services does not depend on one’s financial situation. Most of these initiatives were paused or decelerated due to the change of governments, and when they are renewed with the new government’s establishment, power struggles around these issues will likely also be renewed among stakeholders in the health system.”
THE COVID-19 PANDEMIC: THE CASE FATALITY RATE (in Hebrew)
Kyrill Shraberman
Women in government and compulsory military service contributed to reducing the fatality rate during the COVID-19 pandemic
A new Taub Center study conducted by Kyrill Shraberman examines the variation across countries in the fatality rate from confirmed COVID-19 cases from March 2020 until May 2022 and identifies the characteristics that explain some of the difference in that rate across countries.
Results for Israel were surprisingly good and is on the list of those countries with high-quality healthcare services
The study examined Israel and 95 other countries using variables that can be divided into four categories: economic resources, health capital, government effort, and political culture. Based on the findings, the period of the pandemic can be divided into two periods: the adjustment period from March 2020 to September 2020; and, the stable period from October 2020 to May 2022. During the adjustment period, the main variable that contributed to the rate of fatality from confirmed cases is political culture, while during the period of stability, economic resources and the quality of the healthcare system were the main contributing factors.
The findings also show that the wealthier a country is the more it invested in testing, and, therefore, the more successful it was in reducing the fatality rate, since it could identify patients at an earlier stage and prevent the deterioration of their illness and their deaths. Israel performed well relative to other countries from this perspective, thanks to the greater than expected effort invested by the government considering the country’s GDP per capita.
An expanded index to measure the quality of s country’s healthcare services, developed as part of the research, ranks Israel among the 25 countries with the highest-quality healthcare services. Essentially, only three countries had a lower fatality rate from confirmed cases than Israel during the pandemic (March 2020–May 2022): Iceland, Qatar, and UAE. Thus, Israel stood out relative to other countries.
A particularly interesting finding is that compulsory military service contributed to reducing the fatality rate from confirmed cases, although this was observed only during the adjustment period. “The existence of compulsory military service makes manpower available that is skilled in dealing with emergencies and it can also contribute to better compliance with restrictive policies among the population,” according to Shraberman.
The rate of fatality was lower in countries where a woman had served in the highest political position
Countries with women leaders (a prime minister or president) for a period of at least one year since 2000 had lower fatality rates from confirmed cases during the entire period of the pandemic. It seems that women in senior positions, and in particular senior government positions, tend to make decisions with less risk to the public. An alternative explanation relates to the country’s political culture: in countries with women in leadership there may be a greater tendency to cooperate with the government, particularly in times of emergency.
The main finding of the research is that the performance of the healthcare system in each country during the pandemic was affected by the amount of economic resources available to it at the onset of the pandemic and by the quality of its healthcare system. In order for countries to improve how they will deal with future medical and general emergencies, they need to advance investment in a quality healthcare system as part of an overall policy of sustainable growth.
DEMOGRAPHIC TRENDS IN ISRAEL: AN OVERVIEW
Prof. Alex Weinreb
Several new and unusual patterns were observed in Israel during 2022 in terms of the relative effects of fertility, mortality, and migration on population growth. Taub Center researchers Prof. Alex Weinreb and Kyrill Shraberman examined recent trends in these areas and identified several notable changes: moderate declines in fertility, increases in mortality rates, and positive and strengthening migration rates. If these trends continue, Israel’s population is expected to grow by about 3 million people in less than 20 years. The study also examined some aspects of the relationship between population and environment. The researchers point to heightened exposure to hazardous substances in Israel, especially PM2.5, that are likely to increase rates of morbidity and premature death in the future.
Israel’s population is growing rapidly
In 2020 and 2021, Israel’s population grew by 1.6% and 1.7%, respectively. These were the lowest annual growth rates observed in Israel since the establishment of the state, with the exception of 1985-1988.
In 2022, the population growth rate rose to about 2.1 percent. As a result, Israel’s population is expected to reach 9.65 million by the end of the year, compared with 9.45 at the beginning of the year. Today, the Jewish population in Israel is more than 7 million, the Arab population is more than 2 million, and those who are neither Jews nor Arabs – more than half a million.
In 2021, the fertility rate in Israel rose among Jewish women and declined among Arab Christian women
In the years before Covid-19, the Total Fertility Rate (TFR) in Israel was on a downward trend in every district and in every subpopulation. In 2020, some cities reached extremely low fertility levels, by local standards. For example, in Tel Aviv and Ramat Gan, the TFR dropped well below “replacement level” (the level of fertility needed to maintain population size) – 1.84 and 1.8 children, respectively. Some Haredi and Bedouin communities also experienced sharp fertility declines.
Covid-19 interrupted that downward trend. In 2021, Israel’s overall TFR increased by 0.1 children, reaching 3.0 children per woman. This increase was primarily due to a 0.13 rise among Jewish women. In contrast, among Muslim women, the fertility rate increased by only 0.02 children, among Druze women by 0.06 children, and among women from other sectors by 0.04 children. Only the fertility rate of Christian Arab women continued to decline (by 0.08 children per woman).
The latest available data show that over the first eight months of 2022, fertility returned to its pre-Covid downward trajectory, particularly in the Arab population.
At the beginning of 2022, the mortality rate was particularly high
Driven by particularly high mortality rates in late January and early February 2022, total mortality rates in the first 30 weeks of 2022 were the highest in almost 20 years: 5.7% higher than in 2021, 11.6% higher than in 2020, and 9.8% higher than in 2017–2019.
Net migration rates to Israel continue their rise
In the years preceding Covid-19, immigration to Israel was on the rise and out-migration was on a downward trend. In 2022, immigration surged following the Russia-Ukraine War. In the first nine months of 2022, 52,578 people officially immigrated to Israel. This is almost double the number of people who came to Israel in all of 2021. 2022 immigrants are also different in terms of median age: they are ten years older than their 2021 counterparts.
Exposing Israelis to hazardous materials may increase morbidity and mortality levels in the future
In the section of the study that examines the relationship between population and the environment, three causes of premature mortality were examined: general exposure to fine inhalable particulate matter (PM2.5), occupational exposure to carcinogenic substances and hazardous gases, and exposure to high temperatures. Data show that in Israel, the mortality from exposure to particulate matter is currently lower than the OECD average. However, over the past 20 years, exposure to these particulates has been higher in Israel than in the OECD as a whole, and this will likely contribute to an increase in mortality rates—relative to those countries—in the future. Regarding the other two factors, Israel’s results are much better than those of other developed countries: Israelis have less occupational exposure to carcinogenic substances and dangerous gases, and thus far the direct effects of excess heat on mortality in Israel are very small.
Expansion of built-up areas and relative success in increasing the coverage of trees
More than 51% of land in European OECD countries is covered by trees, grassland and wetlands, compared to only 3.2% of Israel. The share of “artificial surfaces” in Israel (buildings, roads, and similar) has grown much faster in recent decades than in OECD countries. From 1992 to 2019, this share in Israel grew by 3.4 percentage points – about 765 square kilometers – compared to an increase of 1.2 percentage points in Europe. It is also clear that the relative share of built-up areas in Israel (percentage of total land covered by roofed structures) is greater than their share in European countries: 5.2% and 2.5%, respectively. On the other hand, areas covered by trees in Israel have grown faster than in European countries, by 0.32 percentage points between 2004-2019, relative to 0.17 percentage, respectively.
“Understand Israel’s demography is critical, especially the sources of population growth, as they have implications for all systems and areas of life. The shifts in birth and migration patterns are significant, but we need to see if they continue. These demographic data are also closely related to environment shifts in built-up areas, green areas and pollution, all of which affect morbidity levels, life expectancy and the quality of life in general,” said Prof. Weinreb.
TRENDS IN MARRIAGE AND DIVORCE IN ISRAEL (in Hebrew)
Prof. Alex Weinreb
Marriage patterns have undergone many changes in the last forty years in most developed countries. This study by Prof. Alex Weinreb, a demographer and Research Director at the Taub Center, describes recent trends in marriage patterns and divorce rates across Israel’s major religious and ethnic subpopulations.
Reduction in marriage rates
In the years preceding Covid-19, Israel experienced notable declines in the Total Marriage Rate (TMR). Among Jewish women, the percentage of women expected to marry at least once by the age of 55 fell sharply from more than 80% in 2012-2014 to 70% in 2019. Among Muslim and Druze women, the rate fell to just under 75%. Among Christian women, the decline began earlier and it has been stable at around 70% since 2016. The TMR of Jewish, Christian and Druze men also declined between 2015 and 2019, falling below 70%. Among Muslim men, the decline began later. In 2010-2016, it averaged 85%. By 2019, it had dropped to 78%.
For the most part, these declines are the result of an increasing number of people living alone. In other words, although the number of cohabiting (unmarried) couples increased over the 2013-2020 period, their share out of all couples remained stable at about 5%. This is much lower than the rate reported in other developed countries in 2013 – 12% in the US, 13% in Germany, 14% in Ireland, 21% in the Netherlands, 24% in Denmark, and 27% in Norway. The study also points to signs that many cohabiting couples transition into marriage in their thirties.
The declines in marriage rates and the increases in the proportion choosing to remain single are very significant and point towards Israel becoming a marginally less marriage-centered society.
Divorce: Stable among Jews, rising in other groups
The study reports that the divorce rate in the Jewish population between 2008 and 2019 declined from about 10 to 9.1 cases per 1,000 couples. More detailed focus on age-specific divorce rates shows particularly sharp declines under the age of 30, stability at the age of 30, and small increases over the age of 40.
In the Muslim population, divorce rates increased from about 6.5 per 1,000 couples between 2005 and 2007 to 8.2 in 2019, approaching the levels of the Jewish population. Under the age of 25, the divorce rate among Muslims is now significantly higher than that of Jews. Among those aged 25-39, the rates are lower than among Jews and have remained fairly stable, rising only moderately. Above age 40, rates have risen sharply.
Divorce rates have also increased among the Druze and Christians, albeit from a much lower starting point. Even with the increases, as of 2019, divorce rates in these populations were about 60% and 40%, respectively, of the rate in the Jewish population.
Regarding the study’s main findings, Prof. Weinreb says: “Identifying trends in marriage and divorce helps us understand evolving patterns of poverty, inequality, employment, welfare, and health. Without its high marriage rates, Israel would almost certainly have higher levels of inequality, lower life expectancy, and fewer happy people. This is why any change in marriage patterns in Israel deserves attention.”
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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