Israeli Health Leaders Warn of Worsening Doctor Shortage and Urge Reforms
At a health conference, Israeli medical leaders warned of a worsening doctor shortage and urged sweeping reforms, including increased nurse authority, AI adoption, and tackling health disparities.
Israel's healthcare leaders warned on Wednesday at a conference marking 30 years of the National Health Insurance Law that the shortage of doctors is expected to worsen in the coming years. They called on the government to enact significant changes in how healthcare services are provided and managed—ranging from delegating authority to nurses, expanding the use of artificial intelligence and telemedicine, to regulatory reforms and strengthening medicine in the periphery.
Sigal Dadon-Lavi, CEO of Maccabi Healthcare Services, pointed to the gap between population growth and the increase in the number of doctors. According to her, "Demographic growth has risen by 20%, while doctors have increased by only 15%. We will only see the fruits of these steps in 2031, and then we will begin to see an upward trend. This requires us to deal with the 'doctor desert' starting today."
She stated that it is impossible to wait for the number of doctors to grow and that changes must be made immediately in how the system operates. "We must courageously delegate authority to nurses and utilize all existing technology," she said. She also highlighted the problem of wasted appointments: "There is a 'no-show' rate of 20% for appointments that people simply do not attend."
Dadon-Lavi also proposed allowing the services of doctors residing abroad rather than restricting practice exclusively to those with Israeli licenses, as well as exploring a shortened training period for physicians. "We must recognize the major crisis of medicine in Israel, and unfortunately, it is only going to get harder."
Prof. Eitan Wertheim, CEO of Clalit Health Services, similarly focused on the manpower shortage and the need to better manage appointments and the continuum between community care and hospitals. "We need to manage appointments," he said. "The better we can synchronize community treatment and hospital care, the more it will improve. We cannot reach Israeli citizens if we do not increase our workforce, particularly in psychiatry."
According to him, artificial intelligence can become a significant tool in coping with heavy workloads. "Artificial intelligence is an important part. It will free up time for teams to focus on other things," he said. He added that data processing capabilities via AI already exist today, alongside the expansion of home care and remote patient monitoring.
Wertheim also raised a proposal to increase resources dedicated to the healthcare system through a dedicated tax. "There is a need for additional doctors and improved service; we should consider 'putting a dedicated health tax so that the patient receives more.'"
Prof. Eli Sprecher, CEO of the Tel Aviv Sourasky Medical Center (Ichilov), argued that part of the solution lies not merely in increasing manpower, but in changing how the system operates. He noted that the National Health Insurance Law was enacted more than 30 years ago, while medical and technological realities have since changed dramatically.
"The meaning of a 'reasonable distance' has changed significantly," Sprecher said. "We are forgetting the patient themselves. The technology is available, and the main obstacle to its implementation is regulation."
He noted that giving patients greater control and utilizing digital tools could significantly reduce the need for physical doctor visits. "If patients were given more control, 70% would not need to visit a practitioner," he said. He described a scenario where a patient could open an app, input troubling symptoms, and receive initial guidance from the system.
Sprecher also criticized the existing competitive structure. "The price we pay for competition is that there is no single organizational truth in the healthcare system," he said. According to him, the current structure harms the system's ability to act as a unified whole, and the law must therefore be amended to match current realities.
Balancing Routine and Emergency Care
Dr. Michal Mekel, CEO of Rambam Health Care Campus, addressed another challenge facing hospitals in recent years: the frequent transitions between routine and emergency operations. "If I have to shut down the entire hospital every few months and ramp it back up, that is a problem," she said. "I want as little transition from routine to emergency as possible. When the emergency period is so long, you cannot cancel other services. We need to learn how to maintain routine alongside emergency, and I think most hospitals succeed in doing this."
Mekel emphasized that this requires a significant expansion of protected spaces in hospitals. "We need to expand protected areas. For example, building a protected emergency room costs me 75 million shekels—and that is critical," she said.
Competition and Disparities in Healthcare
Prof. Nachman Ash, Chairman of the National Institute for Health Policy Research, addressed the competition among health maintenance organizations (HMOs). He noted that competition is important and can push organizations to invest more in public service, but it also generates distortions.
«Competition is important, it is built on managed competition and drives organizations to invest more in the public. The law provides the infrastructure for this, but there is a very big 'but' here—it also generates damages.»
According to Ash, one of the central challenges is forcing HMOs to compete on service quality rather than just enrolling members. "Transparency must improve. As a citizen, I need to know how to choose based on quality and service data," he said, noting that quality indicators are not sufficiently accessible or published.
Ash also warned against competition focused on demographics deemed more profitable for HMOs: "Often there is competition for specific sectors that are more profitable, competing for the healthy and children, and not enough for the sick."
Dadon-Lavi joined the criticism of how competition is managed, arguing that it is "less healthy and less well-managed." She stated that restrictions on advertising, recruitment call centers, and lead generation have spawned illegal activities that she claims are insufficiently enforced. She proposed abolishing the six fixed annual dates currently set for switching HMOs, allowing members to switch more flexibly while simultaneously limiting the frequency of switches. Furthermore, she called for targeted government intervention to reduce disparities in the periphery, particularly in the north and south.
At the close of the discussion, top healthcare officials were asked to name the single most vital change the healthcare system needs—without using the word "budget." Prof. Ash pointed to the need to redefine the role of local authorities in healthcare and integrate them more meaningfully into the system. Dadon-Lavi urged preparing the healthcare system for the AI era alongside finding solutions for expensive drugs and technologies outside the health basket.
Wertheim called on the state to "place healthcare as a top priority" and strengthen preventive medicine and the public's ability to live healthier lives. Mekel asked to grant hospitals broader managerial powers while the Ministry of Health focuses strictly on regulation. Sprecher highlighted the overarching challenge hovering over all issues raised in the debate: "Finding a solution to the issue of inequality in healthcare."
