Context
The October 7th attacks by Hamas created a sudden surge of patients requiring emergency hospital care. The same day, 1100 patients were admitted to Soroka hospital, a 1,150-bed tertiary referral centre in the south of Israel (Hallel & Haklay, 2021). Within 4 days, approximately 3,000 patients presented at Soroka (Taub Center, 2023) and another 500 patients presented to other local hospitals. The incoming patients predominantly needed trauma, orthopedics, burns, and surgical care.
The Israeli health system has the ability to shift care from the inpatient to the outpatient setting through hospital-at-home services, which have been operated by HPs since the late 1970s. Hospital-at-home services were expanded during the COVID-19 pandemic to help manage the surge of patients requiring inpatient care (The Israel National Institute For Health Policy Research, 2022 (see HSRM archive https://eurohealthobservatory.who.int/monitors/hsrm/hsrm-countries/hsrm/israel/providing-health-services-effectively/maintaining-essential-services). HPs had reduced these services after the COVID-19 pandemic to control costs, despite attempts by the MoH to shift care from the inpatient to the outpatient setting (see HSPM update https://eurohealthobservatory.who.int/monitors/health-systems-monitor/analyses/hspm/israel-2015/shifting-medical-inpatient-payments-from-per-diem-to-global-budgets).
Impetus
As a response to the sudden surge in demand, all hospitals started freeing up beds to treat the victims of the attack and to spare capacity to admit more patients from potential future attacks.
Main purpose of the reform
To free up beds, non-war-related patients who could be discharged were discharged immediately, and non-urgent patients were not admitted. Instead, they were treated at hospitals-at-home.
Content of the reform
Starting October 8th, hospitals temporarily put all elective care on hold and discharged non-war-related patients earlier than planned. These discharges were coordinated with the health plans (HPs), which expanded hospital-at-home services to absorb the non-war-related patients. Hospital-at-home services absorbed both the patients that were discharged from hospital early and suitable new patients that could not be admitted to hospitals due to lack of beds. The Ministry of Health also issued new guidelines to ensure smooth transfer of patients between care settings and to ensure continuity of care (Lexer, 2023). For instance, the guidelines advise that patients should be discharged with a three-day supply of medications and the contact details of a family member; upon arrival at the new care setting, the patient must be identified through a video call with the referring institution.
Implementation steps taken
Implementation was immediate due to the urgency of the situation. No formal evaluation has been conducted to date.