State Comptroller Warns National Insurance Could Soon Run Out of Cash

The report also warns about the health system’s readiness for an older population. At age 65, remaining life expectancy is estimated at 20 years for men and 22.6 years for women, ranking fourth among OECD countries. Only 1.5% of the Health Ministry’s 2025 budget, about 930 million shekels out of 62 billion, is allocated to preventive medicine, and just 4% of older adults were screened by health funds in 2024 for polypharmacy and medication adjustments. In that year, 27% of older adults had more than seven medications listed, while the Comptroller says geriatrics remains a profession in distress because of low pay, a shortage of positions and the use of geriatric doctors as family physicians. He also says geriatric hospitalization beds are expected to keep falling in 2030 and 2040 despite Health Ministry efforts to increase them.

The report says preventive care has also declined. With the exception of cholesterol testing, all measured indicators fell in 2024 compared with 2019, including flu vaccination and early colon cancer detection. Roughly 91% of documented preventive and health-promotion actions in health-fund computer systems were not carried out. Among older adults, 99% of records related to home adaptations for fall prevention were not completed, and 75% related to calcium and vitamin D supplementation were not completed. The main barriers, according to the report, are structural, including lack of time, no reward for preventive work and shortages of professional staff such as clinical dietitians. Physicians and older adults also cited a lack of knowledge as the main reason preventive steps were not taken.

A separate survey found that 51% of older adults had not been exposed to information about volunteering after retirement, while 82% of those who feel lonely, 26% of all older adults, were not identified by the Welfare Ministry, National Insurance, or the Ministry for Social Equality. Only about 1% of retirees from 2020 to 2024 took part in retirement-preparation workshops. The Comptroller recommended expanding employment programs for older adults, creating additional programs, and improving access to volunteering information and retirement-preparation resources. National Insurance responded that it remains committed to serving older adults, noted the 2018 reform followed years of criticism, and argued that retirement pensions have not been raised for more than a decade.