Israel has returned relatively quickly to the familiar situation before the COVID-19 pandemic, characterized by a low rate of public expenditure on healthcare. However, it needs to adjust to the post-crisis reality – the war against Hamas – while continuing to plan for the long term to deal optimally with challenges. So say researchers at Jerusalem’s Taub Center for Social Policy Studies in the chapter on healthcare in its 2023 State of the Nation Report.
The chapter, written by Taub researchers Prof. Nadav Davidovitch (who is also dean of Ben-Gurion University of the Negev’s School of Public Health), Natan Lev, and Dr. Baruch Levi, presents a status report on the healthcare system in Israel before the war and shows some of the challenges and problems facing the system, as well as efforts to cope with these issues.
On the one hand, 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 issued in the healthcare field.
Israel’s healthcare system
Israel gets poor marks for being ranked in the lower third of the OECD countries in national healthcare expenditure. In 2022, the national expenditure on healthcare at 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.
Regarding 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 were 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 at close to 60%. Nonetheless, there has been a decline in their number over the past decade, primarily following the Yatziv Reform that 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 Israeli medical schools, which is 2.2 times the number issued in 2010. However, this increase, they wrote, 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 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 stressed that, in the past few years, the Health Ministry 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, particularly in the periphery. The ministry has produced a plan that officials say will 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, the number of beds is expected to grow by about 11% in coming years, but given 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 – with the per-capita number of beds highest in Tel Aviv and Haifa, while it is lowest in the South.
