The Paradox of Israel’s Healthcare System: Between National Achievements and Ongoing Erosion

State of the Nation Report 2025 – Chapter: Health Trends

Looking at the state of healthcare in Israel reveals a paradox. On the one hand, life expectancy in Israel is high and continues to rise, placing it among the leading high-income countries. The healthcare system also functioned well during the most recent war, and Israel’s health outcomes are very good in international comparison. On the other hand, national investment in Israel’s healthcare system is among the lowest in the OECD. This situation does not appear sustainable; even today, early cracks in the system’s resilience can be identified, such as the spread of measles.

The researchers Prof. Nadav Davidovitch, Natan Lev, and Ofir Gonen present an overview of Israel’s healthcare system in 2025. They focus on critical issues such as workforce, expenditure, service availability, health disparities, population health status, and the impacts of the war. The chapter also proposes several ways to address the challenges ahead to ensure that the healthcare system can continue to provide high-quality services to all residents in the decades to come. The chapter places special spotlights on the rise of the advanced and specialist nurse and on the measles outbreak, which to date has claimed the lives of 12 children.

The healthcare system paradox: low investment alongside impressive achievements

Healthcare in Israel is a national paradox. Despite one of the lowest levels of national investment among high-income countries, the system continues to show outstanding achievements, foremost among them a life expectancy of 83.8 years, placing Israel fourth among these countries, along with the ability to provide high-quality care even in emergencies and wartime, as demonstrated over the past two years. These achievements reflect exceptional professional and human capacity. At the same time, the researchers warn that resilience is not limitless, and that without increased investment in health, these achievements may be lost.

Budget data reveal a troubling picture. National health expenditure has indeed risen slightly in absolute terms, but international comparisons show that Israel still ranks near the bottom. In 2024, national health expenditure stood at only about 7.3% of GDP, compared with an OECD average of 9.3% of GDP, and about 33.7% of this is financed directly out of residents’ pockets.

National expenditure on healthcare as a percent of GDP

The medical workforce crisis

Israel’s healthcare system is facing a severe workforce crisis, which poses a significant threat to its ability to continue providing high-quality services. The survey shows that Israel suffers from an ongoing shortage of physicians and active nurses compared with other high-income countries. Israel has 3.5 active physicians per 1,000 population, compared with an OECD average of 3.9, and only 5.57 active nurses per 1,000 population, compared with an OECD average of 9.5.

In recent years, several significant steps have been taken to address the crisis, such as investing in expanding the number of medical students trained in Israel and the rise of new healthcare professions such as the advanced practice nurse, but these steps are expected to affect workforce shortages only in the long term, not immediately.

A shortage of healthcare infrastructure and persistent inequality alongside steps toward change and greater efficiency

The healthcare system suffers from a severe shortage of infrastructure and persistent inequality between the geographic center and the periphery and across population groups. Israel ranks low in the number of general hospital beds, with 1.76 beds per 1,000 population — substantially below the OECD average of 3.18 beds per 1,000 population. In addition, waiting times for specialist (consultative) medicine are long (particularly in neurology and endocrinology, around 50 days). These are among the many signs indicating a system operating at the edge of its capacity.

Beyond erosion in infrastructure and workforce, substantial gaps are evident in access to, and quality of, healthcare services between the geographic center and the periphery. For example, cancer patients living in the periphery must travel long distances to receive high-quality care.

The largest gaps are evident in the health indicators among the Arab population. The life expectancy gap between Jewish and Arab residents stands at 3.6 years — 84.3 years among Jews compared with 80.7 years among Arabs. The infant mortality rate per 1,000 live births among the Arab population stands at 5.2 — double that among Bedouins in the Negev — compared with 1.9 among the Jewish population.

It should be noted that in recent years several steps toward change and greater efficiency have been taken. The system has begun implementing the Choice Arrangements Reform, which improves patients’ access to specialists and certain services beyond their health fund. Initial steps are also being taken to formalize the status of advanced and specialist nurses, and the use of digital medicine is expanding. Implementing such measures, alongside increased public investment in health, is key to preserving and improving Israel’s national achievements in healthcare.

The measles outbreak: A tragic result of unjustified distrust in the vaccine system

One of the most troubling failures in public health in recent years is the tragic case of the measles outbreak. In 2018–2019, about 4,300 cases were reported to the Ministry of Health. In April 2025, another outbreak was recorded: about 2,000 cases were reported, 730 patients were hospitalized — most of them children — and 12 children died. The main outbreak centers were in the Haredi population, where the combination of low vaccination rates and high population density enabled rapid spread.

Analysis of the outbreak shows that the spread of the epidemic stemmed from pockets of unvaccinated people, due to poor access to services and, above all, vaccine hesitancy. It is important to emphasize that this distrust is wholly unjustified, since the measles vaccine is highly effective in preventing the disease and safe to use.

To ensure that vaccine-preventable diseases do not claim additional victims, every effort is needed to increase public trust in vaccines and in the healthcare system, using local intermediaries and opinion leaders, with an emphasis on sectors where vaccination gaps were found. In parallel, Israel’s vaccination system must be ensured broad and effective coverage, through dedicated resource allocation, investment in research, and tailoring strategies to local needs.