Executive Summary
The relative decline in COVID-19 in 2022 and its being regarded as part of the “new normal” has allowed the Ministry of Health and other stakeholders to return to routine issues that were on the healthcare system’s agenda prior to the outbreak of the pandemic. Taub Center research by Dr. Baruch Levi and Prof. Nadav Davidovitch examined the healthcare issues in need of attention including health inequalities, healthcare workforce shortages, and the interrelationship between public and private healthcare. The study’s findings indicate a shortage in medical and nursing staff, primarily in the periphery, and a notable shortage in acute care hospital beds. The research also touches on the “health paradox.” While Israel lags behind in expenditure on healthcare, workforce, and infrastructure, it still places high in worldwide terms of life expectancy and healthy life expectancy as well as low rates of infant mortality.
Personnel and infrastructure in the healthcare system
The share of active physicians in Israel in 2020 remained stable compared to the previous year and continued to be 3.3 doctors per 1,000 population, slightly lower than the OECD average of 3.6 doctors per 1,000 population. The share of active nurses in Israel also remained stable, and, in 2020, was 5.1 nurses per 1,000 population. This is a considerably lower than in the OECD countries where the average is 8.9 nurses per 1,000 population.
It is important to note that for both physicians and nurses, the share of older professionals in Israel is relatively high: 49% of active physicians are aged 55 or older — the second highest rate in the OECD (after Italy). The share of nurses in Israel over age 55 increased from 23% in 2000 to 39% in 2020. In the coming years, the healthcare system will face a challenge in finding qualified healthcare professionals.
The share of physicians in the Tel Aviv district (which has the highest rate) is 2.3 times higher than their rate in the Northern district (which has the lowest), and the share of nurses in the Haifa district (the highest) is 2.05 times higher than their rate in the Southern district (the lowest). Due to workforce shortages which are especially severe in the periphery, the Ministry of Health initiated the Ilanot program for medical leadership in the Negev and Galil, with the goal of strengthening the medical workforce in the periphery. The program’s first cohort which began in October 2022 included 30 students in the Negev and 30 in the Galil.
With regard to healthcare infrastructure, like MRI machines, CT machines, and acute care hospital beds, Israel ranks low relative to other OECD countries. General hospital bed occupancy rates in Israel are among the highest of the OECD countries; only Canada has higher occupancy rates. In 2020, the average length of stay for general hospitalization patients in Israel was 4.6 days, as it was in the previous year. There has been a moderate and gradual decrease in this figure throughout the last decade (4.8 days in 2010). Only in Türkiye is the length of stay in general hospital admissions lower than in Israel (4.5 days on average), whereas the average length of hospitalization in the OECD countries is about 6.6 days. During periods of pressure, like the flu season, hospitals and hospital wards are so full and it is likely to have a negative impact on the health of those in care.
In addition to high occupancy rates, waiting times for medical consultations in Israel are also notably long relative to those in other developed countries. The waiting times for dermatology consults are extremely high (over 30 days). The waiting times for other medical consultations range from 15 to 20 days on average. Comparing 2021 and 2019, there has been a slight increase in waiting times for some specialties, while a decrease has been observed for others. In 2020, there was a decrease in waiting times for all specialties. This may be related to the decrease in demand for non-urgent healthcare services during the COVID-19 pandemic. In general, it seems that the issue of long waiting times is also dependent on geographic location, with long waits mainly in the Negev region.
Lifestyle and risk behavior
As of 2020, the smoking rate in the adult population (ages 21 and over) in Israel is 20.1%. The share of men smokers is higher than the share of women smokers (25.6% versus 14.8%). Smoking is more prevalent among Arabs than among Jews (24.4% compared to 19.1%, respectively). The COVID-19 pandemic has had a negative effect on the smoking habits of Israelis: 26.8% of the interviewees in the survey who were smokers reported that since the beginning of the pandemic they smoke even more and they reported an average increase of 13 cigarettes per day. Among teenagers, there has been a notable drop in the number reporting that they have tried smoking cigarettes or hookah. Unlike cigarette consumption, alcohol consumption in Israel is one of the lowest in the OECD countries. In 2019, the average alcohol consumption among those aged 15 and over was 3.1 liters per capita per year.
A less encouraging finding is the rise in diabetes in Israel. As of 2019, the prevalence of diabetes in Israel is approximately 6.2%, compared to 5.5% on average in the European Union countries. Since the year 2000, the prevalence of diabetes in Israel has increased by about 94% (at that time the rate of diabetes patients was 3.2% of the population). The prevalence of diabetes among adults in the age range of 20‒79 reaches about 8.5%.
With regard to life expectancy, both men and women in Israel are at the top of the OECD country ranking for high life expectancy. As in all developed countries, women’s life expectancy is higher than that of men (84.8 years compared to 80.6 years). Another index in which Israel excels is Healthy Life Expectancy (HALE), in which Israel ranks sixth in the world. Nevertheless, there are discrepancies between population groups, geographic districts and even towns in measures of life expectancy, infant mortality, and incidence of chronic disease, as well as measures of risk factors life smoking and obesity.
The public healthcare system in Israel has suffered for many years from neglect and erosion of funding which has resulted in long waiting times and disparities between the geographic center of the country and the periphery in terms of health and health outputs (workforce and hospital beds). There has also been a rise in investment in private health insurance — processes that primarily harm weaker population groups. In 2022, the Ministry of Health led several initiatives to deal with the problems of workforce in the healthcare system and to rein in private healthcare treatment. It should be allowed to implement and complete these initiatives and be given adequate resources, as well as inter-ministerial support and cooperation to strengthen the healthcare system in the country.