Medical Tourism in Israel

Medical tourism operates as a paid channel through which foreign patients receive planned care at Israeli hospitals and medical centers, either directly or with an intermediary coordinating the patient, institution, physician, and insurer.[1][3] Reported annual patient totals and revenues have varied substantially because the available figures cover different years, institutions, and measures of income. Since 2018, the sector has operated under legislation governing agents, institutional responsibilities, accounting, patient information, and safeguards for Israeli patients.[2]

An early strand of Israeli medical tourism dates to the 1960s, when German patients with psoriasis began traveling to the Dead Sea for treatment, with German government health organizations subsidizing the visits under diplomatic and trade agreements.[4] Israel began attracting medical tourists on a larger, hospital-based scale around 1990, with foreign patients seeking care at institutions including Hadassah, Sheba (Tel Hashomer), and Rambam.[4]

By 2004, Israel was identified among countries actively promoting medical tourism, and one distinctive offer combined infertility treatment with tours of religious sites.[5] Israel's hospitals had developed particular strength in assisted reproduction: every major Israeli hospital supported clinical activity in in-vitro fertilization and related methods, and from 1990 onward approximately five percent of articles in the leading journals Fertility and Sterility and Human Reproduction came from Israel.[6] Tel Hashomer (Sheba) Hospital, under Bruno Lunenfeld's leadership, became internationally recognized as a center for research and treatment of female infertility.[7]

Growth accelerated through the 2000s and early 2010s. Activity in government hospitals rose by 50% between 2010 and 2012, following growth of hundreds of percent over several preceding years.[8] A 2011 report estimated approximately 16,000 medical tourists, while a 2013 headline gave a figure of 35,000.[9][8] Later reporting put the total at around 60,000 in 2014, followed by a decline to roughly 30,000 in 2016 attributed to the collapse of the Russian ruble and Ukrainian hryvnia, which made Israeli medical services significantly more expensive for patients from those countries.[3]

Medical tourism in Israel typically involves an agent acting as intermediary between the patient, hospital, treating physician, and, in some cases, the patient's insurer abroad.[3] Agents may arrange hospitalization, liaise with foreign insurance companies, convey medical records, communicate with physicians, and look after patients during the process.[3] Treatments sought span oncology, fertility care, surgery, diagnostic examinations, specialist consultations, and hospitalization.[1]

Patients traveling abroad for medical care are generally advised to consult their home physician beforehand and to obtain supplemental insurance covering medical evacuation in the event of unforeseen complications.[10] Under the 2018 law, a medical institution must provide a written invitation setting out the estimated diagnosis, proposed treatment, significant risks, prognosis, and price information, and written confirmation must generally be obtained before the patient's arrival.[2]

The Knesset passed the Medical Tourism Law, 5778–2018, on July 18, 2018, and it was published on July 28 of that year.[2] The law established a regulatory framework addressing both the agents who broker services and the medical institutions that provide them.

A person or company arranging medical tourism for patients generally must be registered as a medical travel agent with the Ministry of Health.[2] Registration is valid for four years and may be renewed for further four-year terms. Applicants must maintain an address in Israel or, if nonresident, a representative in Israel; they must not be employed by a medical institution; and they must not have a disqualifying criminal conviction. The Ministry of Health's director may refuse registration on grounds of unfitness but must give the applicant an opportunity to be heard and provide written reasons.[2] An exception covers qualifying institution-controlled websites where the institution controls the advertisement and contract terms and the patient pays only the institution.[2]

The law requires an agent to act faithfully, fairly, and in the standard manner toward both the patient and the treating institution, and to protect the confidentiality of medical information received from patients.[2] An agent generally may not arrange care at an institution in which the agent has a personal interest or a relationship with staff unless the interest is disclosed and the patient provides written consent. Agents must also visibly identify themselves as medical travel agents while working in a medical institution.[2]

A medical institution may treat medical tourists only if it can provide adequate care and if its main activity, and that of the relevant department, remains the treatment of patients who are not medical tourists.[2] Its written invitation must set out the estimated diagnosis and supporting documents, required tests, proposed treatment, significant risks, and prognosis; public institutions must also direct patients to the Ministry of Health's fee schedule.[2]

Institutions may not give medical tourists priority in treatment quality, appointment availability, resource allocation, or auxiliary services.[2] Public medical institutions generally may not treat medical tourists during regular operating hours, subject to specified exceptions. Separate accounting for medical-tourist activity is mandatory, and institutions must submit annual information about services provided to tourists and their relative scope.[2] Enforcement mechanisms include Ministry of Health inspectors, disciplinary procedures, criminal fines and imprisonment for arranging medical tourism without registration, and financial levies on institutions that breach their obligations.[2]

Annual arrivals were estimated at approximately 30,000 in 2019, with annual sector turnover put at close to NIS 1 billion.[1] Under the 2018 law, agents brokering medical tourism generally must be entered in the Medical Travel Agents Registry, subject to specified statutory exceptions.[2]

The majority of patients have come from Russia, Ukraine, Kazakhstan, and other parts of Eastern Europe, with smaller numbers reported from African and European countries.[3] Patients have also come from Cyprus and neighboring countries.[1] At least a few thousand patients annually were reported to come from the United States, attracted in part by orthopedic procedures estimated at roughly half the U.S. price; savings of 25–35% after travel and accommodation were cited.[11] Medical tourists were estimated to account for roughly 2% of all visitors to Israel.[3]

Revenue figures from different years and measures illustrate both the sector's growth and the difficulty of making direct comparisons. Medical-tourism revenue was reported to have risen from NIS 54 million in 2009 to NIS 119 million in 2011, with medical tourists spending nearly $5,000 per visit compared with roughly $1,500 for sightseers.[12] Total associated spending, including hospital, hotel, and other outlays, was put at $140 million in 2012.[11] An audit covering five large government hospitals found NIS 347 million in medical-tourism revenue in 2013, up 23% from 2012; Ichilov's revenue rose from NIS 91 million in 2012 to NIS 155 million in 2013, while Sheba's fell from NIS 129 million to NIS 116 million.[13]

Israel's health system provides residents with a broad range of high-quality services and technologies, largely free at the point of service under the 1994 National Health Insurance Law.[14] Universal health coverage through statutory insurance was introduced in 1995, with residents choosing among competing nonprofit health plans.[15] The system's well-equipped hospitals, strong medical academic culture, and established clinical infrastructure help explain Israel's attractiveness as a medical-tourism destination.[14]

Reporting on the sector has identified hospitals including Sheba, Hadassah, Ichilov, Rambam, Wolfson, Assaf Harofeh, and Beilinson.[4][13] Hospitals have stated that revenue from foreign patients supports investment in equipment and services benefiting all patients.[1]

Following normalization agreements between Israel and Gulf states, policymakers and analysts identified medical tourism as a potential area for expanding bilateral ties. An analysis attributed to Israel's Ministry of Tourism noted that Gulf states had invested in medical tourism and international hospital collaborations. It estimated that at least 30% of people in the Gulf were more likely to seek private hospital treatment and described Israel as a possible important destination.[16]

A 2021 joint report by the Institute for National Security Studies, the Atlantic Council, and the Emirates Policy Center described medical tourism as "another opportunity, albeit of more limited scope, to encourage travel between the two states," noting that Israel's health sector already had experience promoting the country as a medical-travel destination.[17] These assessments framed Gulf-related medical tourism as an emerging opportunity rather than an established patient flow, and neither provided projected patient volumes or specific participating hospitals.

The growth of medical tourism in Israel prompted sustained debate over whether the sector benefits the public health system or disadvantages Israeli patients. Proponents argued that payments from foreign patients generate revenue that hospitals can direct toward equipment, services, and physician retention.[4][1] Critics contended that expansion within an already crowded public system could worsen access for Israelis, while some experts considered its impact negligible so long as patient numbers remained relatively modest.[4]

A Finance Ministry Accountant General audit found that at Ichilov in 2013, approximately 75% of medical-tourist operations occurred in the morning, despite ministry rules described in the audit as restricting such procedures to after 3 p.m.; at Wolfson, 82% of reviewed patient files showed medical services during morning hours.[13] The audit also documented agent commissions of 10–20% at Ichilov and Sheba and up to 30% at Rambam, Assaf Harofeh, and Wolfson, as well as instances of hospital employees acting as agents.[13] Ichilov disputed parts of the draft findings, asserting that some complex cancer operations required morning scheduling and that it had expanded afternoon operating-room capacity for Israeli patients.[13]

Waiting-time data from 2013 illustrated the access disparity in concrete terms: at Sheba, 36% of Israelis waited more than 64 days for a non-urgent MRI under anesthesia, compared with 6% of medical tourists; at Rambam, 100% of medical tourists received non-urgent MRIs, with and without anesthesia, within a week, compared with 24% and 17% of Israeli patients respectively.[18]

During 2017 Knesset committee deliberations, industry and chamber of commerce representatives warned that strict restrictions, particularly an afternoon-only rule for hospital procedures, could drive patients to competing destinations such as Germany or Turkey and potentially cause the sector to collapse.[19][3] The 2018 law ultimately incorporated safeguards against prioritizing medical tourists while establishing registration, transparency, accounting, and reporting requirements.[2]

A separate legal matter involved three Ichilov surgeons suspected of receiving private payments from medical tourists in connection with operations performed at the public hospital. Prosecutors ultimately closed the case after a hearing, concluding that they could not prove beyond reasonable doubt that the payments were made to guarantee a particular surgeon's involvement and could not exclude the defense account that the payments covered separate private consultations and accompaniment services. The absence of regulation during the relevant period was reported to have contributed to ambiguity over what conduct was permissible.[1]