Health in Israel

Israel's healthcare system is organized around compulsory national health insurance, providing universal coverage to residents through a government-stipulated basket of services.[1] The National Health Insurance Law was enacted by the Knesset on June 15, 1994, and the statutory insurance system took effect at the beginning of 1995.[7][2] Every resident must register with one of four nonprofit health funds: Clalit, Maccabi, Meuhedet, and Leumit.[1][2] The funds compete for members while being required to provide a broad, uniform benefits package; they must accept applicants regardless of age or health status.[1][4]

The law's guiding principle is that care should be delivered according to medical need rather than the insured person's ability to pay.[2] Health-insurance contributions are collected by the National Insurance Institute and distributed to the funds according to a weighted formula that accounts for membership and demographic factors, including age and distance from health facilities.[8][1] Other funding comes from government allocations, member fees and premiums, taxes, and additional sources.[9][1] In 2024, national health expenditure reached NIS 146.0 billion, equivalent to 7.3% of GDP. The detailed financing section of the CBS release attributes roughly 42% to the government budget and 23% to the Health Tax, while household out-of-pocket payments represented 19.9%.[10]

Beyond the statutory basket, residents may purchase supplementary coverage offered by the health funds or separate commercial private insurance.[11][2] This three-tier structure has become increasingly significant: private-insurance expenditure as a share of household health spending rose from 18% in 2000 to 37% in 2018.[12] The Ministry of Health supervises the four funds, sets medical standards, licenses medical personnel, maintains food and drug quality standards, promotes medical research, and serves as the principal public-health and environmental-medicine agency.[8][13]

Organized healthcare in the Land of Israel predates the establishment of the state by several decades, growing out of communal necessity rather than government initiative. Early Jewish immigrants in the late Ottoman and early British Mandate periods encountered malaria-infested swamps, the absence of plumbing and running water, and virtually no healthcare facilities; workplace accidents compounded the hazards.[3] These conditions prompted organized workers to seek collective solutions.

On December 18, 1911, a convention of 150 workers in Petah Tikvah passed a resolution recognizing the need for a health fund financed by members' dues.[3] At Berl Katznelson's urging, the new fund was built on collective savings, contributions according to income, and mutual guarantees—principles that would endure through successive reforms.[3] In 1920 the fund was taken over by the Histadrut labor federation and became Kupat Holim Clalit. Between 1911 and 1913, twelve Tel Aviv physicians also organized the Hebrew Medical Association, workers in the Judean colonies and Jaffa created the first sick fund in Palestine, and the predecessor of Hadassah established Jerusalem's first public-health nurse service. That service later developed into the Tipat Halav preventive-care network for pregnant women and infants.[4]

During the British Mandate period, the government established a Government Health Service in 1920, while Jewish and Arab institutions, Hadassah, the Histadrut Sick Fund, voluntary sick funds, missions, charitable societies, private physicians, and hospitals provided services in parallel.[4] By 1946 the Histadrut Sick Fund operated two hospitals and 274 clinics, with health stations in Jewish cities, towns, and rural settlements.[4] At Israel's establishment in 1948, the fund continued operating as what one historical account calls a "mini-ministry," while the new Ministry of Health assumed formal responsibility for healthcare and preventive services.[4]

By the end of 1948, Clalit covered 80% of people who had health insurance in the new state, a group then comprising 53% of the population.[3] Two major post-independence challenges dominated the following decades: extending medical services to Arab communities, particularly in rural areas, and caring for the large wave of Jewish immigrants.[4] The Ministry of Health took over most well-baby clinics, and government hospital construction during the 1970s expanded the ministry's direct role in hospital provision.[4]

The mid-1980s saw rising medical costs and budget pressures. In 1985–1986, sick funds contributed almost 45% of national health expenditure while the government contributed approximately 22%; the Histadrut-affiliated Kupat Holim covered about 70% of the population, and other sick funds covered a further 20%.[13] The Ministry of Health functioned as the principal public-health regulator and provider of last resort, filling gaps where no nongovernmental agency was present.[13] The 1980s were also characterized by efforts to increase private-sector participation in response to fiscal constraints.[4]

The drive toward systemic reform culminated in the work of the State Commission of Inquiry into the Israeli Health System—the Netanyahu Commission—which reported to the government in 1990.[7] The commission identified unclear citizen entitlements, uncertain divisions of responsibility among government, sick funds and providers, and excessive centralization as fundamental defects.[7] Its proposals for a defined basic-care package, bringing most financing under public auspices, and restructuring the Ministry of Health formed the blueprint for the legislation that followed. On June 15, 1994, the Knesset voted to enact the National Health Insurance Law, with the new framework taking effect in January 1995.[7][2]

The four nonprofit health funds are the operational backbone of the system, delivering curative care through neighborhood primary-care clinics and regional specialist centers and contracting with hospitals and other public and private providers.[14] At the end of 2017, total health-fund membership approached 8.5 million; Clalit held approximately 54% of members, Maccabi 25%, Meuhedet 12%, and Leumit 8%.[15] Membership patterns varied considerably by locality: Meuhedet held 44% in Beit Shemesh and 38% in Jerusalem, while Maccabi held 48% in Tel Aviv and Holon but only 10% in Jerusalem.[15]

Clalit Health Services, the direct descendant of the 1911 Kupat Holim, is Israel's largest health provider and, in the cited account, operated 14 hospitals and more than 1,200 clinics.[3] Around 2000, the General Health Fund operated 1,200 primary-care clinics. The mother-and-child care network had grown from 120 centers in 1948 to 800 by 2000; 520 were operated by the Ministry of Health and Clalit, while the remainder were run by the Jerusalem and Tel Aviv municipalities and Hadassah.[14]

The statutory basket covers visits to general practitioners, pediatricians, and gynecologists without direct payment, together with basic tests, nursing services, and most listed medicines, although approved medicines may involve a copayment.[16][17] Eyeglasses and most adult dental care are generally outside the national-insurance basket, although health funds may subsidize them and supplementary plans offer additional services.[17] The basic benefits package has been extended since 1995 to include mental healthcare and dental care for children.[1]

Public funding flows to the health funds through health-insurance contributions collected by the National Insurance Institute, Ministry of Health and government-budget allocations, member payments, and other sources.[9][1] Funds are distributed according to a weighted average of each fund's members, calculated using age, distance from a health facility, and other Ministry of Health criteria.[8] New immigrants are covered by national health insurance from the day they register and must choose a health fund; their fees are income-based.[17]

The supplementary tier has grown substantially. In 2017, supplementary plans offered by the health funds generated NIS 4.7 billion in revenue.[11] Private insurance has increasingly served as an upgrade to supplementary coverage, particularly for access to life-saving drugs not included in the state basket.[11] In 2013, private financing accounted for 40% of national health spending—up from 30% in 1995—and included dental care, insurance premiums, private-clinic visits, medicines, copayments, and medical equipment.[18] By 2024, household out-of-pocket payments and other private financing represented 19.9% and 13.7%, respectively, of national health expenditure.[10]

A 2024 academic assessment characterizes the 1994 law as transforming the system from a social-security-based, Bismarckian model into a universal, single-payer system with managed-competition elements among public nonprofit sick funds. It argues that partial privatization after enactment, driven largely by funding cutbacks, made the system more unequal and less efficient.[19] A 2015 health-system review, by contrast, characterizes the system as relatively efficient, attributing its performance to regulated competition among health plans, tight controls on hospital-bed supply, accessible professional primary care, and a well-developed electronic health-record system.[1]

Israel's community-based care spans general practitioners, specialists, and medical consultants outside hospitals. It is organized through the health funds' clinic networks and extends from family-medicine practices to well-baby clinics, multidisciplinary clinics, and specialized institutions.[2] The system is universal and primary-care-led, with care beginning in family medicine and community health centers.[2]

Preventive services are delivered largely through the mother-and-child care network, which provides prenatal examinations, immunizations, regular pediatric checkups, early detection of physical and mental disabilities, and health education.[14] The National Insurance Institute pays a hospitalization grant to the hospital or medical institution where an insured person is hospitalized for childbirth. In return, the institution provides birth-related treatment, maternal and newborn hospitalization, care for premature babies, and newborn hearing screening.[9]

Preventive-care participation rates are notable by international comparison. In 2013, 72.9% of women aged 50–69 received mammograms, versus an OECD average of 56.5%, and 61% of Israelis over 65 received flu vaccinations, against an OECD average of 50.4%.[20] Adult smoking prevalence stood at 20.7% in 2021, while annual alcohol consumption was 3.0 liters per capita against an OECD average of 8.6 liters; Israel ranked fifth in daily adult fruit and vegetable consumption.[6]

Digital infrastructure has been a particular strength. Israel digitized medical records for the entire population through health-fund electronic records more than 25 years ago, and a national Health Information Exchange connects providers and gives doctors access to patients' historical health data at the point of care.[21] In 2005, Clalit and four major medical centers formed a secure network enabling real-time access to integrated medical records across 18 hospitals and 1,000 clinics without centralizing the underlying data.[22] A transparency website launched in 2014 provides information about National Health Insurance and voluntary-insurance benefits to help insured people understand and claim their entitlements.[23] The Ministry of Health also publishes quality measurements, waiting-time and follow-up indicators, and patient-satisfaction rates; reported satisfaction across the health funds stands at 90%.[21]

Hospital care is provided through a mix of Ministry of Health-owned general hospitals, sick-fund hospitals, and other nonprofit and private facilities.[24] The ministry continues to own and administer many general hospitals and directly pays for some services, including geriatric institutional care.[24] As of 2022, general-care hospital beds numbered 1.75 per 1,000 residents.[25]

By international standards, Israel's hospital-bed supply is low. A 2013 comparison found 1.91 beds per 1,000 residents against an OECD average of 3.4 and linked the limited supply to an average occupancy rate of 98%; occupancy in pediatric and internal-medicine wards could reach 170% in winter.[20] An earlier 2010 comparison found two beds per 1,000 people against an OECD average of 3.8, with occupancy at 92% versus the OECD's 75%.[26] A 2023 equity report showed regional variation in bed availability: 2.3 per 1,000 in Haifa and Tel Aviv, 1.9 in Jerusalem, 1.5 in the North, and 1.4 in the South, against a national average of 1.716.[27]

Diagnostic equipment is also below the cited OECD norms: the 2013 comparison put Israel at nine CT scanners and 2.5 MRI scanners per million residents, compared with OECD averages of 23.6 and 18.7, respectively.[20] Hospitals face overcrowding and extended waits for surgery, procedures, and tests, with population growth, aging, chronic illness, staff shortages, and underfunding expected to intensify these pressures.[2]

The workforce profile shows a relatively adequate physician supply alongside a notable nurse shortage. The 2013 comparison counted 3.3 doctors per 1,000 residents, slightly above the OECD average of 3.2, and 4.8 nurses, compared with an OECD average of 8.8.[20] Selected indicators recorded 3.4 physicians per 1,000 residents in 2021 and 4.8 nurses per 1,000 in 2022.[25] The Ministry of Health anticipated that the physician-to-population ratio would fall because retirements were outpacing new entries to the profession.[20] Personnel shortages, increased workloads, and inadequate infrastructure remain compounding pressures.[2]

Israel's population-level health outcomes rank among the strongest in the developed world. For 2020–2024, life expectancy at birth was 85.1 years for females and 80.8 years for males in the total population.[5] In 2024, total-population life expectancy was 83.3 years—unchanged from 2023—with 81.1 years for men, tied for seventh in the comparison, and 85.4 for women, ranked eighth.[5] An OECD report covering 2022–2023 put Israel fourth-highest in life expectancy among developed countries in that comparison at 83.8 years, including those killed during the 2023 war.[28]

The long-run trajectory is striking. Female life expectancy rose from 73.4 years in the early 1970s to 84.8 in 2022, while male life expectancy rose from 70.1 to 80.7 over the same period.[29] In 2009, Israel ranked fourth among OECD countries in life expectancy at 81.6 years, behind Japan, Switzerland, and Spain, against an OECD average of 79.3; a projection made at the time suggested approximately 86 years by 2030 if the earlier trend continued.[30] From 2022 to 2023, life expectancy rose by almost a full year for men and women.[28]

Before the COVID-19 pandemic, life expectancy at birth in 2019 was estimated at 81 years for men and 85 years for women—8.8 years higher for men and 7.4 years higher for women than the averages in Egypt, Jordan, Syria, and Lebanon.[6] Israeli life expectancy was characterized as among the world's highest in that comparative context.[6]

Infant mortality has fallen sharply. In 2022, it stood at 2.8 deaths per 1,000 live births, compared with approximately 9.6 per 1,000 among Jews and 18.0 among Muslims in 1986.[25][13] An estimated national figure of 2.7 per 1,000 compares with an average of 15.1 in Israel's direct neighboring countries.[6] In 2021, the Jewish-population rate was approximately 1.9 per 1,000—similar to Southern European rates despite a higher proportion of high-risk births among Haredi women occurring without prenatal checkups.[6]

Leading causes of death in 2021 included cancer, accounting for 22.8% of deaths; heart disease, 12.6%; and COVID-19, 9.5%.[25] New cancer cases in 2020 numbered 31,876, a rate of 346 per 100,000 people.[25] A 2016 WHO report attributed approximately 6% of deaths in Israel to type 2 diabetes, compared with an OECD average of 2.9%.[6] Among Israeli Jews, age-adjusted heart-disease and stroke mortality was reported as lower than in Southern Europe, while suicide rates were comparable.[6] Preventable mortality was reported at 134 deaths per 100,000 people in 2022–2023, second-lowest after Switzerland and down from 170 in 2010.[28] In 2022, 83.4% of people aged 20 and over assessed their health as good or very good.[25]

Israel's health system is notable both for what it has achieved and for the conditions under which it developed. Starting from pre-state communal initiatives organized amid malaria, inadequate sanitation, and minimal infrastructure, the system was built incrementally through worker solidarity, voluntary association, and eventually state institutions.[3][24]

Life expectancy of 83.3 years in 2024 places Israel among the countries with the highest life expectancy in the OECD comparison; the OECD's 2022–2023 figures ranked Israel fourth among the developed countries covered.[5][28] Infant mortality, estimated at 2.7 per 1,000 births, is far below the average in Israel's direct neighboring countries, while the 2021 rate among the Jewish population was reported as similar to Southern European levels.[6] Preventable mortality of 134 per 100,000—second-lowest after Switzerland in the cited comparison—reflects performance in prevention, early detection, and treatment.[28]

These achievements have been sustained despite health spending below the OECD average.[28][1] Regulated competition among health plans, accessible professional primary care, controls on hospital-bed supply, electronic health records, and high preventive-care participation have been identified as contributors to the system's relative efficiency.[1][21] Israel's early population-wide adoption of electronic health records positioned it as a leader in health-data infrastructure, supporting care coordination, quality measurement, and research.[21]

The system's significance cannot be separated from unresolved tensions. Persistent geographic, ethnic, and socioeconomic disparities, hospital overcrowding, an expanding private tier, and workforce shortages require continuing structural responses.[2][1] The trajectory from the 1911 Petah Tikvah workers' convention to a national system with more than 8 million health-fund members reflects both the ambitions of Israeli institution-building and the continuing challenge of making universal healthcare equitable in practice.[3][15]

Despite strong population-level outcomes, Israel's health system exhibits persistent disparities along ethnic, geographic, socioeconomic, and linguistic lines. Access differences are physical, cultural, and linguistic, and some peripheral areas lack certain services altogether.[2]

Differences in life expectancy and infant mortality between Jewish and Arab populations have been documented over several decades, although the gap has narrowed. Historical data from 1985 recorded life expectancy of 73.9 years for Jewish men and 72.0 for non-Jewish men; infant mortality was 9.6 per 1,000 among Jews and 18.0 among Muslims in 1986.[13] In 1995 Arab life expectancy was reported as 2.3 years shorter than Jewish life expectancy, while 1996 infant mortality was 4.9 per 1,000 among Jews and 9.7 among Arabs.[31] For 2020–2024, life expectancy was 85.5 years for Jewish women and 81.7 for Jewish men, compared with 82.1 for Arab women and 77.1 for Arab men.[5] The 2023 equity report presented somewhat different period figures: 85.8 and 81.5 for Jewish women and men, and 83.2 and 78.2 for Arab women and men.[27]

Infant-mortality disparities remain significant. The 2023 equity report recorded two deaths per 1,000 live births for the general population, 5.3 for Arab society overall, and 9.2 for Arab communities in the South.[27] Type 2 diabetes is also more prevalent among the Arab population: among people aged 30–55, the cited age-specific incidence rate was two to three times higher for Arab women than Jewish women and 1.5 times higher for Arab men than Jewish men.[6] A 2020 Physicians for Human Rights Israel report, drawing on CBS data, identified gaps in life expectancy, infant mortality, morbidity, self-assessed health, diabetes, obesity, and smoking, particularly in community primary care.[32]

Geographic disparities are also documented. The 2023 equity report recorded physician availability of 5.5 per 1,000 people in Haifa and 5.0 in Tel Aviv, compared with 3.2 in the North and 2.7 in the South, against a national average of 3.9.[27] Availability of community care and specialists in the periphery is considerably lower than in the center, while central Israel and Jerusalem offer broader opportunities for supplementary and commercial insurance.[2] Supplementary-insurance coverage also varies by city: a 2010 survey found coverage among 88% of Tel Aviv residents and 60% of Jerusalem residents. Private insurance outside the health funds was held by 41% in Rishon LeZion, 35% in Haifa, and 32% in Tel Aviv, but 18% in Jerusalem.[33]

Health disparities are associated with socioeconomic status, geography, ethnicity, country of origin, religion, and gender.[24][31] Analyses attribute them to a mixture of differences in access and service quality, lifestyles, and health-promoting behaviors rather than to a single cause.[6] Access to insurance for asylum seekers was a specific concern in 2020: recognized refugees received access to the national healthcare system, while asylum seekers generally could enroll only through employers, and those without employer-provided coverage had access only to emergency care.[32]

One defining feature of Israel's health system is its ability to deliver strong outcomes at spending levels below OECD norms, a characteristic attributed to structural efficiencies but also associated with mounting strain. A 2015 review found health spending below 8% of GDP and nearly 40% privately financed, yet characterized the system as relatively efficient and comparable to other developed countries in health-status indicators.[1] For 2022–2023, Israeli health investment was reported at 7.6% of GDP, compared with 11%–12% in Germany, Austria, and Switzerland.[28]

An analysis drawing on 2018 Taub Center figures put public expenditure on medical care at 7% of GDP, against 10% in developed countries.[12] The 2015 review attributes relative efficiency partly to regulated competition among health plans, tight controls on hospital-bed supply, accessible professional primary care, and a well-developed electronic health-record system.[1] These mechanisms have supported good outcomes while the system operates under significant resource constraints.

The growth of private financing is a major systemic challenge. Private-insurance expenditure as a share of household health spending rose from 18% in 2000 to 37% in 2018.[12] In 2013, private financing accounted for 40% of national health spending, up from 30% in 1995; by 2024, combined household out-of-pocket and other private financing represented approximately 33.6%.[18][10] A 2024 academic assessment argues that partial privatization, driven largely by funding cutbacks, made the system more unequal and less efficient. A separate account links the erosion of public resources in part to the elimination of employer contributions to health-fund payments.[19][18] Private-sector expansion can create inequity through differences in waiting times, movement of personnel toward private services, and private use of public resources.[2]

The Finance Ministry has argued that Israel's younger population means age-adjusted health spending would be approximately 9% of GDP, while the CBS has acknowledged that spending appears higher when population age is taken into account.[18] The 2015 review identifies reliance on private financing as a challenge with potentially harmful effects on equity and efficiency, alongside efforts to reduce inequalities, shorten surgical waiting times, and publish comparative performance information.[1]

Dental care has been a specific focus of expansion. In 2010, dental care for children up to age eight was added to the health basket through the health funds without requiring supplementary insurance. The change followed a petition to the High Court of Justice and legislative committee proceedings, while arrangements for further extension were still being developed.[34] The 2015 review confirms that the basic benefits package was extended to include dental care for children.[1]

Workforce projections have also raised concern. A 2013 report expected the physician-to-population ratio to fall because retirements were outpacing newly licensed doctors despite efforts to expand medical-student places.[20] Projected shortages of physicians and nurses, increased workloads, and inadequate infrastructure are expected to intensify as the population ages and grows.[2]