Overview

Israel’s public healthcare system is advanced by international standards but falls behind other Western countries in the number of hospital beds, doctors and nurses and public spending ratio. In 2020, due to Covid-19, Israel spent 8.5% of its GDP on healthcare, an increase compared to past expenditures, but still less than the OECD average of 9.7%. Israel provides universal coverage to the population via four independent health management organizations and a network of hospitals, community clinics and specialized doctors. Israeli healthcare facilities are modern and are open to new, cost-effective technologies and procedures. Many Israeli doctors receive training in the United States and maintain personal and professional relationships with U.S. colleagues at major medical centers. Israel’s healthcare policy makers have focused on promoting healthy nutrition and lifestyle, preventive medicine and screening.

Israel is a global technology research and development center. Its strength in this sector stems from inter-disciplinary capabilities, which bring together medicine, clinical expertise, materials science, electronics, software expertise and engineering know-how. Israeli development centers of multinational companies have an annual turnover of billions of dollars.

Primary healthcare industry opportunities for U.S. companies are within the area of healthcare technology, including medical devices and pharmaceuticals. The pandemic has led to a change in funding for health tech companies: the industry raised $14.7 billion in new funds in the first half of 2021. This amount is more than in the whole of 2020, which itself was around double 2019’s level. While much of the industry is still privately financed, options for public investors have also increased with eleven new health tech companies going public in 2021 in the U.S. alone.

Source: Trade Policy Information System (TPIS) & TradeStats Express

Healthcare Market Trends and Demographics  

Local and International Competition

Israel is a sophisticated and mature market. U.S. suppliers face intense competition and should therefore be ready to compete and support their local distributors through educational presentations, material and lobbying/advocacy. Major multinationals and large companies have established direct sales and marketing offices in Israel. Other exporters operate through local distributors. There are hundreds of medical distributors that are well-established throughout the country.

Hospital Care to Homecare

As of 2018, the Ministry of Health (MoH) is working to implement new procedures and expand the shift from hospital care to homecare. The MoH also continues to improve the national patient medical record system, both for the benefit of the patient and for clinical research purposes.  

Digital Health

The well-developed infrastructure and high-tech industry offer innovative tools and applications. The Ministry of Health and Digital Israel are leading a national program that aims to harness and leverage the opportunity inherent in the digital revolution and progress of information and communication technologies. In 2021, the Digital Health sector raised a record $1.9 billion and innovation labs are spearheading the adoption of AI technologies and computational science to solve therapeutic challenges.

Aging Population

The aging population creates multiple challenges for Israeli society. The need to cope with the steadily increasing number of elderly people with dementia is one of Israel’s healthcare system major challenges. The Ministry of Health developed a national strategic plan to address Alzheimer’s and other types of dementia and age-related chronic diseases. The plan offers a holistic perspective and emphasizes collaboration among all relevant agencies: government ministries, the health plans and other organizations. The strategic plan aspires to cope with key issues that make it difficult for the current service system to provide an appropriate response to the unique needs of elderly patients.

Increasing Private Health Spending

The proportion of private financing in national health spending in Israel (28.8% in 2020), on top of the health tax (21.4% in 2020), continues to rise. According to the Israel Central Bureau of Statistics, the proportion of private spending is 50.2%, making it one of the highest rates in the Organization for Economic Cooperation and Development (OECD). The trend is clear and consistent, resulting from an erosion of the public healthcare system’s resources. Private spending is composed of payments for dentistry (most dentistry in Israel is not included in the state health basket), supplementary and commercial health insurance, private care, purchases of medications, deductible payments and purchases of medical equipment.

The rate of public spending has not changed since 1995. The government refrains from increasing the health system’s financial resources, despite population growth and technological requirements. Among other things, every purchase of an MRI machine, or a machine used in cancer radiology treatments, requires a special license.

Source: The Knesset Research and Information Center 

Demographics

Source: Israel Central Bureau of Statistics

Registration Process

The MoH has an overarching regulatory and policy making role.

U.S. companies interested in exporting medical devices or pharmaceuticals to Israel need to appoint a local distributor, agent or other legal representative to register their products. The device registration application should be accompanied by a 510(k), Pre-Market Approval or an Investigational Device Exemption. Pharma registration is more complex and requires additional testing and clinical investigation on top of the product file and FDA certification. The average time it takes to obtain a market approval from the Ministry of Health is 150 days for medical devices and about 360 days for pharmaceuticals.

Technical Standards

The Standards Institute of Israel (SII) is the agency responsible for the development of most product standards, compliance testing, and certification of products and industry quality assurance system. Israel has stated its intention to follow international standards whenever possible. However, it has been reported that some standards still exist that tend to favor domestic producers over foreign manufacturers. Electronic medical devices must comply with Israel’s electric standard of 220 V, 50 Hz and are subject to an electric safety test in Israel.

Reimbursement

Israel’s reimbursement system, known as “Healthcare Basket”, includes all the services, medications, supplies and medical equipment that the insured is entitled to receive according to the National Health Insurance Law. It was originally determined based on the health services that were provided by the Ministry of Health and the Clalit Health Fund as of January 1, 1994, and has been regularly updated by the Ministry of Health, based on recommendations by a public committee.

The following fields of service are included in the healthcare basket:

• Diagnosis, consultation and medical treatment
• Medications according to a list, some of which are provided only for a particular indication
• Hospitalization in a general hospital
• Rehabilitation, including hospitalization
• Accessories and medical supplies; and
• Medical services in the work place. 

There are several health services that, as of now, have not been transferred to the health funds and remain the responsibility of the state:

• Well-baby clinics and inoculations
• Certain general rehabilitation devices, walking and other mobility devices, for which the Ministry of Health participates in the cost
• Health services for schoolchildren; and
• Nursing home stay.

Leading Sub-Sectors

Israel has a growing elderly population and limited resources. As a result, the MoH announced shifting hospital care to homecare when possible. This shift will continue increasing the demand for cost-saving products and for products that help patients monitor their health at home. Wound care, advanced diagnostics and minimal invasive procedures continue to be a high priority in the public healthcare market. In addition, well-developed private sector health care in the areas of dental, eye laser surgery and plastic/aesthetic surgery keep up the demand for advanced medical instruments and appliances. Israel has an excellent digital health tech base and is a world leader in mobile and e-health implementations. Opportunities exist , in further advancing drug monitoring and disease surveillance. Other top sales prospects include minimally invasive surgical instruments and technologies that are integrated with imaging capabilities, cardiology equipment, equipment and supplies for plastic surgery, smart implants, dental instruments, equipment and technologies for pain management, physiotherapy, ozone & oxygen therapy, OR equipment and cost-saving, single-use products, point of care diagnostic kits and wound management technologies.

Opportunities

The U.S. Commercial Service at the U.S. Embassy, Tel Aviv Branch Office, in Israel helps American exporters enter the Israeli market through partner search and trade promotion programs. For additional information, please contact Commercial Specialist Yariv Moravnik Shavitt at: Yariv.Moravnik-Shavitt@trade.gov.   

Resources

• Israel Central Bureau of Statistics -  www.cbs.gov.il
• Trade Data
• Ministry of Health:  http://www.health.gov.il/English/Pages/HomePage.aspx
• Ministry of Finance Government Procurement Administration (http://www.mission-ny.mod.gov.il/Pages/default.aspx)
• Israel Central Bureau of Statistics – 2021 Highlights
• Start-Up Nation Central – Digital Health Highlights 2021
• The Knesset Research and Information Center