Israel Journal of Health Policy Research最新文献

Background: The COVID-19 pandemic created unprecedented challenges for healthcare systems, particularly affecting specialized services like pediatric dental care. This study examined geographic disparities in emergency dental service access for children during the first COVID-19 lockdown in Israel.

Methods: We analyzed data from a major healthcare provider serving 25% of Israel's population, comparing 6,024 emergency dental visits of children under 12 across three time periods: pre-pandemic (March-May 2019), first lockdown (March-May 2020), and post-lockdown (March-May 2021). Using spatial analysis methods, we evaluated the distribution and accessibility of emergency dental services across four main geographic regions through metrics including Load Ratio (LR), Geographic Availability Index (GAI), and Rate of Change in Service Utilization (ROCSU).

Results: During the lockdown, emergency visits decreased by 40.2% compared to the pre-pandemic period, with significant regional variations ranging from 31.2% in the Northern region to 44.8% in the Central region. The mean age of children seeking emergency care during lockdown (6.2 years) was significantly lower than in both pre-pandemic (7.1 years) and post-lockdown periods (6.8 years). Analysis revealed substantial regional disparities in service burden, with the highest Load Ratio in the Central region (1.86) and lowest in the Northern region (1.24), despite the Central region having the highest Geographic Availability Index (2.46). The Jerusalem area had the highest proportion of invasive treatments (40.4%) and swelling/abscess cases (22.4%). Ultra-Orthodox neighborhoods demonstrated distinct utilization patterns, with a lower decrease in emergency visits (29.8-36.8%) compared to the national average (40.2%).

Conclusions: This study identified significant geographic inequities in emergency dental care access during crisis periods, with a paradoxical relationship between service availability and utilization across regions. Our analysis suggests that emergency dental service planning should incorporate strategic facility placement to minimize travel barriers, consideration of population-specific utilization patterns, and balanced resource allocation that maintains proportional service capacity across diverse geographic contexts. These findings provide important insights for health system preparedness to ensure equitable access to essential pediatric dental services during future crises.

Background: Appropriate procurement of blood cultures (BC) is essential for diagnosis of bacteremia and susceptibility testing. This includes (1) adequate preparation of the venipuncture site to minimize contamination; (2) obtaining ≥ two sets with a time interval before starting antibiotics. Although these recommendations are standard since the 1960s, adherence is far less than expected - which may adversely impact on the management of bacteremic patients.

Aims of study: This single-center study conducted in Shaare Zedek Medical Center aimed to decrease the proportion of contaminated BCs and to increase the percentage of obtaining two sets of BC/ blood-culture-taking episode.

Methods: Determination of both markers at baseline, then monthly for one year, then subsequently on a quarterly basis; showing data from all departments in real-time to all department directors; and providing short educative lectures during departmental staff meetings, at baseline and after 1-2 years. These markers were adopted as one of the hospital-wide quality measures.

Results: In the 20-year period 2000-2019 more than 1 million BCs were obtained, of which 70% were from patients ≤ 72 h in hospital. During the 5-year study (2020-2024), the percent of blood-culture-taking episodes from which two culture sets were obtained increased annually by ± 16% from a baseline of 27% (9010/33306) in 2020, to 46% (18462/40191) in 2024 (Incidence Rate Ratios, IRR 1.16 [95%CI 1.13-1.18], p < 0.001). This improvement was observed in almost all departments and was especially profound in the emergency department (ED), starting at a baseline of 19% (1979/10326) and increasing to 53% (5304/9915)(IRR 1.33 [95%CI 1.27-1.39], p < 0.001). During the same period, the annual proportion of false-positive BCs, from which only contaminants were isolated, decreased annually by 18% from 2.4% (1592/65230) in 2020 to 1.3% (895/68991) in 2024 (IRR 0.82 [95%CI 0.77-0.88], p < 0.001). This improvement was observed in all departments: in the emergency department, this rate decreased from 3.3% (676/20529) to 1.56% (272/17459) (IRR 0.79 [95%CI 0.75-0.83], p < 0.001).

Conclusion: A simple educational intervention, combined with meticulous data mining and presentation of each department's results, with comparison of all other departments, led to significant and sustained improvement in measurable markers.

Background: We sought to examine patterns of opioid prescriptions in Israel, focusing on the extent to which patients received prescriptions from multiple physicians and physicians prescribed opioids to few or many patients.

Methods: We conducted a historical cohort analysis using a data repository of Clalit Health Services (CHS), Israel's largest health maintenance organization (serving about five million individuals), between 2010 and 2020. We included all non-oncological adult patients registered with CHS who received opioids during the study period. We examined the number of physicians prescribing opioids to each patient and the number of patients prescribed opioids per physician. We also assessed the difference in opioid prescription patterns based on whether patients were registered with the prescribing physicians.

Results: During the study period, 868,499 adult patients filled 5,600,598 opioid prescriptions. Half of the patients received opioid prescriptions from a single physician, filling 3% of the total morphine milligram equivalents (MME) dispensed. In contrast, 11% received opioid prescriptions from more than five physicians, filling 85% of all MME dispensed. There were 9008 physicians who prescribed opioids in 2010, and 15,486 in 2020. The percentage of physicians prescribing opioids to more than 50 patients/year increased from 7% in 2010 to 12% in 2020. The proportion of MMEs prescribed by those physicians increased from 36% in 2010 to 81% in 2020.

Conclusion: We found that a small number of patients received the great majority of opioids, and a small number of physicians prescribed the great majority of opioids. Based on our results, we suggest policy options that would have minimal impact on most patients and most prescribers but would make a meaningful contribution to limiting opioid overprescription.

Aim: Healthcare systems struggle to balance priorities within complex settings. This analysis aims to identify cross-national insights and trade-offs in healthcare policy by examining how five high-income countries navigate accountability, autonomy, equity, trust, satisfaction, and system effectiveness - competing parameters that shape system performance and public experience.

Methods: A structured comparative analysis was conducted across five national healthcare systems: Israel, the Netherlands, Germany, the United Kingdom (UK), and the United States (US). Publicly available literature, including peer-reviewed studies, policy reports, and population surveys, was synthesized using a narrative approach due to variation in data definitions and context.

Results: The Netherlands and Germany demonstrate relatively balanced performance across all parameters, supported by regulated insurance models. Despite universal coverage, the UK system faces sustained access failures and eroding public satisfaction. The US underperforms in equity and satisfaction but demonstrates strengths in specific clinical domains. Israel combines strong statutory coverage with growing reliance on supplementary and private insurance, raising concerns about long-term equity and regulatory coherence.

Conclusions: Each system reflects different strengths and trade-offs across the examined dimensions. The findings highlight structural tensions between autonomy and accountability, equity and access, decentralization and fragmentation, and public versus private provision that shape overall system performance. These insights are relevant for health systems seeking to enhance care delivery in an effective and patient-satisfying manner, and they support cross-national dialogue on designing resilient and equitable health systems.

Globally, 46.2% of all adults report having gambled in the previous 12 months. While most experience no negative repercussions from gambling, individuals who are highly engaged in gambling are at greater risk of problem gambling (PG). Studies point to the psycho-social, environmental, and socio-demographic risk factors associated with gambling and PG, and the associated harm to individuals, families, and society, making it a public health concern worldwide. Israel has a relatively regulated conservative gambling market where casinos and electronic gambling machines are banned, and online gambling is only permitted for sports betting. Nevertheless, Israel has a relatively high percentage of PG. This study was designed to characterize involvement in gambling behavior during the previous year in non-gamblers, low-frequency, and high-frequency gamblers as a function of socio-demographic, health, and psycho-social risk and protective factors, and differentiate between problem and non-problem high-frequency gamblers. A representative sample of 3224 Israeli Jews and Arabs filled in an online questionnaire in 2022. The findings showed that 50.7% were non-gamblers, 33.8% were low-frequency gamblers, and 15.5% were high-frequency gamblers. Compared to non-gamblers, low-frequency and high-frequency gamblers were associated with Jewish ethnicity, low levels of financial self-efficacy and neighborhood cohesion, a greater likelihood to smoke and drink, and having a significant other (family/social network member) with perceived excessive gambling. Male gender and traditional self-perceived religiosity were associated with both low-frequency and high-frequency gamblers as well, but to a greater extent with high-frequency than low-frequency gamblers. Online gambling, stress, low financial self-efficacy, using social welfare allowances for gambling, having a significant other who engages in perceived excessive gambling, and identifying as an Israeli Arab were all associated with PG in high-frequency gamblers. These findings suggest that despite its conservative regulated market, gambling in Israel exceeds international averages. The similarities between low-frequency and high-frequency gamblers in terms of risk factors may hint at a type of gambling normalization. Regulatory reforms informed by public health policies are recommended to decrease access to gambling, including banning online gambling and curbing special gambling offers timed to coincide with welfare payments. Awareness campaigns, culturally sensitive prevention programs are recommended, as well as studies to monitor gambling harm.

Background: The October 7th, 2023, attack in Israel and the ensuing war exposed Israeli youth to intense and prolonged traumatic stress. This study aimed to: (1) examine the prevalence of probable post-traumatic stress disorder (PTSD) among Israeli adolescents, and (2) identify associated risk and resilience factors for PTSD symptoms within the context of prolonged exposure to threat and uncertainty due to ongoing war and conflict.

Methods: A cross-sectional digital survey was conducted between October and December 2024. Data were collected from 744 adolescents aged 14-18 years, including the Child PTSD Symptom Scale (CPSS-SR-5), questions about direct war-related consequences and indirect exposure. Personal resilience was assessed using the Connor-Davidson Resilience Scale. Social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS). Background questions addressed age, gender, health, and adverse events in the past year. Hierarchical multiple regression analysis was used to examine the contribution of background variables, war-related effects, indirect exposure, and resilience factors to PTSD symptoms.

Results: The study revealed that 41.9% of participants met the probable diagnostic threshold for PTSD. Gender (female), poorer health status, and previous adverse experiences correlated with increased symptom severity. Among the direct effects, economic status deterioration and direct war impact emerged as significant predictors. Among the indirect exposure factors, frequent news consumption was associated with higher PTSD symptoms. Personal resilience and family support were associated with reduced PTSD symptoms, although resilience factors did not significantly moderate the adverse impacts of war-related experiences.

Conclusions: The high prevalence of probable PTSD among Israeli adolescents in the wake of the October 7th, 2023 attack suggests an urgent need for action. Evidence-informed mental health policies and services should prioritize adolescents, with targeted support for high-risk groups. Our findings stress the need for a national mental health policy to incorporate youth-centered trauma response systems, including interventions for indirect media trauma. Strengthening personal resilience and bolstering family support systems is vital in order to mitigate the lasting psychological impact of war-related trauma on youth.

Background: The first five months of 2025 marked a sharp and troubling increase in child injuries involving All-Terrain Vehicles (ATVs) in Israel. During this short period, 17 children were reported as injured or killed in ATV-related incidents - three fatally - with a mean age of 12.5 years (median: 14). This represents a 263% rise compared to previous annual rates, highlighting serious concerns regarding the effectiveness of existing legislation, enforcement and public awareness. The purpose of this study is to analyze long-term trends in ATV-related child injuries and assess the urgent need for regulatory and preventive interventions.

Methods: We conducted a retrospective analysis of unintentional childhood injuries involving ATVs using Beterem Safe Kids Israel's media-based pediatric injury database, from 2008 until May 2025. Trends over time were analyzed using best-fit regression models, and group differences were tested using chi-square tests of independence.

Results: Between 2008 and May 2025, 378 ATV-related injuries among children and adolescents were documented, including 41 fatalities. A clear upward trend was observed, with the annual average rising from 21.9 cases per year (2008-2019) to 43 cases per year (2020-2025), and with 22 cases already reported in 2025. Severe and fatal cases more than doubled during this period. Arab children were overrepresented relative to their population share. Incidents peaked during weekends and holidays. A significant quadratic increase in mortality rates over time was identified (R² = 0.751, P < 0.001). ATV-related injuries were disproportionately concentrated among children from lower socioeconomic backgrounds, with 95% of Arab victims and 74% of Jewish victims residing in low- or mid-ranking municipalities.

Conclusions: ATVs present an escalating and preventable danger to child safety in Israel, with recent data signaling a critical and worsening trend. Immediate and decisive action is imperative. Policymakers must urgently implement a uniform minimum age for ATV operation, mandate safety technologies (e.g., Operator Protective Devices), require physical capability assessments, and launch targeted public awareness and enforcement campaigns-especially in rural and underserved communities. These measures are essential to safeguarding children and reversing the alarming trajectory of ATV-related harm.