Palliative and Hospice Services in Israel

Caring for patients at the end of life is becoming a central concern of health systems. The belief that palliative and hospice services are the most appropriate for the terminally ill, and that everyone has a right to these services at the end of his life, is gaining ground in health systems throughout the world, including Israel. However, the idea has yet to gain a firm hold. This study provides a comprehensive, up-to-date picture of palliative and hospice services in Israel, examines their characteristics, cost, and quality and identifies unmet needs.

The following are among the study’s principal findings:

  • Hospital- and community-based palliative and hospice services exist in Israel, but to a very limited extent, treating less than 10% of those who could benefit from them.
  • Israel’s three hospital-based hospices and seven home hospice units rely on multiple sources of financing, such as Clalit Health Services budgets, the sale of services to other health plans, and philanthropic contributions.  Consequently, their existence is precarious; this impedes their ability to expand their activities.
  • All of the home hospice units have a multi-professional staff, which visits most patients frequently, and is available 24 hours a day.  However, the units differ significantly in the frequency of these visits and their patterns of care.
  • About two-thirds of home hospice patients are treated concurrently by other services, primarily community clinics and oncology services in hospitals.
  • The average cost per patient of medical services during the last two months of life was NIS 19,437 for patients in home hospice units and NIS 52,248 for similar patients not in home hospice units.  This difference in cost is due primarily to fewer hospital admissions and laboratory tests for home hospice patients.
  • Patients and their families were satisfied with home hospice services, especially physical care. However, a need was expressed for greater emotional and psychological support.

In the past year, the findings were presented to decisionmakers in Israel’s Ministry of Health and health plans, as well as to representatives of American Jewish Federations and service providers. They provide insight into decisionmaking and policymaking regarding the development of palliative services and hospice units in hospitals and the community.  They have informed the work of a committee appointed by the director-general of the Ministry of Health, whose recommendations for setting guidelines for palliative care have been adopted in full by the ministry.  Presentation of the findings to representatives of American Jewish Federations spurred the development of a national training program in palliative care, spearheaded by ESHEL – The Association for the Planning and Development of Services for the Aged in Israel and Ben Gurion University.  The research team continues to be involved in evaluating these processes.

The study was conducted with the support of a grant from the National Institute for Health Policy and Health Services Research, and ESHEL – The Association for the Planning and Development of Services for the Aged in Israel.

Citations in the professional and academic literature

Rosen, B., Waitzberg, R., & Merkur, S. (2015). Israel: Health system review.

Tamir, O., Singer, Y., & Shvartzman, P. (2007). Taking care of terminally-ill patients at home—the economic perspective revisited. Palliative Medicine21(6), 537-541.

Bentur, N., Emanuel, L. L., & Cherney, N. (2012). Progress in palliative care in Israel: comparative mapping and next steps. Israel journal of health policy research1(1), 9.

Rosen, B., Waitzberg, R., & Merkur, S. (2015). Health systems in transition. Health17(6).

Bar-Ze’ev, Y., Singer, Y., & Shvartzman, P. (2015). Evaluating the need for palliative care services at a general hospital in Israel. Journal of palliative medicine18(9), 790-793.

Feder, S. L., Collett, D., Haron, Y., Conley, S., Meron, T., Cherny, N., & Schulman-Green, D. (2018). How skilled do Israeli nurses perceive themselves to be in providing palliative care? Results of a national survey. International journal of palliative nursing24(2), 56-63.