Overview

Key points

• Israel has a National Health Insurance (NHI) system that covers all residents regardless of payment of contributions.
  
• Four competing health plans (HPs) act as service providers and payers. They operate nationwide and cannot reject enrollees.
  
• Coverage is comprehensive, although foreign workers must take out private health insurance, and adult refugees, asylum-seekers and undocumented migrants are not covered. Their children however are covered, provided parents pay a monthly contribution.
  
• Health spending per capita is lower than the EU average, particularly public spending. Out-of-pocket (OOP) spending per capita has decreased since 2005 and is similar to EU levels but with voluntary health insurance (VHI) playing a more important role.
  
• The Israeli system achieves a high level of efficiency and performs better than the OECD average on quality and access to care.
  
• The drawback of low public spending is sub-optimal financial protection, with 5.7% of households facing catastrophic health spending and high unmet needs due to cost (11% of adults) in 2021.
  
• There is an emphasis on primary and specialist care in the community, with 41% of spending on ambulatory primary and preventive care and low acute hospital bed numbers.
  The rate of doctors per capita is likely to fall because 25% are over the retirement age of 67 years. The rate of nurses is already low.
• There are disparities in the availability of care, with the southern region most underserved.
  
• Waiting-times and distance issues are encouraging the use of private health care, often funded by VHI, widening disparities.
  
• Virtual visits were common before, but expanded during the COVID-19 pandemic and after the October 2023 attack by Hamas.
  
• Life expectancy is high and premature mortality rates are low and declining.
  
• Excess mortality in the COVID-19 pandemic was a quarter of the WHO European Region average.
  
• Behavioural risk factors such as smoking and unhealthy diets are below the OECD average but still major contributors to mortality.
  
• Mortality from diabetes and the percentage of people classified as overweight is above the EU average.