Home Hospitalizations in Israel Surge, Outpacing 17 Internal Wards

Home hospitalization in Israel has seen a dramatic increase, growing from a few hundred days in 2018 to approximately 162,000 days in 2024, according to a new Ministry of Health report. This expansion means that about one-tenth of internal ward hospitalizations in the reviewed departments in 2024 occurred at the patient's home. The service, initially an experimental model, has become a significant component of internal hospitalization care.

Dr. Hagar Mizrahi, head of the Ministry of Health's Medicine Division, stated that the goal is to expand the service not just as a solution for hospital overcrowding, but as part of a broader shift towards more flexible and patient-centered healthcare. The report highlights that while home hospitalization is growing, its establishment as a stable alternative to hospital stays faces systemic, organizational, budgetary, and operational challenges.

The Israeli healthcare system has long contended with overloaded hospital wards, exacerbated by a declining number of general hospital beds per capita compared to OECD averages and high bed occupancy rates. Projections of significant population growth, increased life expectancy, and accelerated aging in the coming decade will further strain demand for healthcare services.

In response, the Ministry of Health began incentivizing health maintenance organizations (HMOs) in 2018 to develop acute home hospitalization services as an alternative for less complex cases. By 2026, hospitals' roles as home hospitalization providers were formalized, with permanent incentive mechanisms established through 2030 and a dedicated budget of approximately NIS 220 million allocated over five years.

The report identifies several barriers to the service's full potential, including difficulties in recruiting and retaining qualified staff, a lack of regulation and oversight for external home care providers, and the absence of a national measurement infrastructure to assess care quality and safety. Budgetary uncertainty among HMOs, stemming from reliance on temporary ministry funding rather than core budgets, also hinders long-term planning and investment.

Furthermore, some medical teams still lack full confidence in home hospitalization, viewing it as suitable only for mild cases, which can lead to appropriate candidates remaining hospitalized. Financial incentives are also misaligned, as hospitals do not gain significant savings from early patient discharge, and the budget support is directed towards HMOs. The average cost of a home hospitalization day provided by a hospital is also considerably higher than when provided by HMOs or external suppliers.

Studies indicate that for suitable populations, home hospitalization yields comparable or even better clinical outcomes than institutional care, including similar or lower mortality and readmission rates, higher patient satisfaction, and a reduced likelihood of transfer to long-term care facilities. These benefits are partly attributed to avoiding hospital-acquired infections, delirium, and physical decline associated with prolonged bed rest.

The typical home hospitalization patient is elderly, with 73% aged 65 and over, and the average age being 72. Common diagnoses include infections treatable at home, such as pneumonia, urinary tract infections, cellulitis, dehydration, and heart failure. The average length of home hospitalization is 4.4 days.

Concurrently with the rise of home hospitalization, internal ward hospitalization metrics have declined. In 2024, general internal medicine wards saw an average occupancy rate of about 87%, and geriatric internal wards about 67%, representing a decrease of approximately 12% and 25% respectively compared to 2019. The report suggests potential for expanding home hospitalization to areas like pediatric acute care, post-surgery care, obstetrics, oncology, cardiology, and psychiatry.