National Insurance Disability Assessments Significantly Higher Than Health Fund Evaluations

A comparison by the State Comptroller's office revealed significant discrepancies between disability assessments conducted by the National Insurance Institute and those by a health fund for the same elderly individuals. In 75% of cases, the National Insurance Institute assigned a higher dependency level, averaging 1.7 levels higher on a six-level scale. These assessments, based on the Katz scale and measuring the same daily functions and need for supervision, are expected to yield similar results given they were performed within 30 days of each other.

While health funds conduct in-person assessments by nurses and geriatric doctors, the National Insurance Institute relies heavily on medical documents, with only about 1% of assessments performed at the elderly person's home. Israel is unique among OECD countries for systematically conducting these assessments without direct patient contact. The discrepancy is most pronounced for individuals deemed independent by the health fund, where the National Insurance Institute identified 82% as needing care, with nearly 39% qualifying for the highest care levels.

These higher assessments by the National Insurance Institute translate into substantial financial implications. The average point difference was approximately 2.5, and the estimated annual cost of one additional dependency level for all elderly individuals is about 5.6 billion shekels, suggesting the observed 1.7 level difference incurs an excess cost of around 9.5 billion shekels annually. The number of recipients of long-term care benefits has surged from approximately 180,000 in 2018 to an estimated 392,000 in 2025, with expenditures rising from 7 billion shekels to 21.1 billion shekels in the same period.

In response to these findings, the National Insurance Institute is reviewing its assessment methods. It plans to increase in-person assessments in areas with significant discrepancies and is considering using video calls and AI tools to identify cases requiring home visits. Meanwhile, individuals receiving conflicting assessments can request a review, an in-person examination, and submit documentation from the health fund's assessment.