Israel’s healthcare system is advanced by international standards. With that, compared to other Western countries, Israel’s healthcare system is lacking in number of hospital beds, doctors and nurses per capita. In 2022, Israel spent 7.6% of its GDP on healthcare, an increase compared to past expenditures, but still less than the OECD average of 9.3%. Israel provides universal healthcare coverage to Israeli citizens and permanent residents via four independent health management organizations (HMOs) and a network of  mandated benefit packages, including hospital, primary, specialty, mental health, and maternity care, as well as prescription drugs and other services. Israeli healthcare facilities are modern and are receptive to innovative 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 is a global technology research and development hub. 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. As a result of the robust local ecosystem, many multinational companies establish research and development centers in Israel, that generate an annual revenue of billions of dollars. The Israeli government actively promotes health tech innovation and adopted a national “bio-convergence” strategy in 2021.

Healthcare technology, including medical devices and pharmaceuticals, provides opportunities for U.S. exports. 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 United States alone.

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.

Shifting from 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

Known as the ‘Startup nation’, Israel has positioned itself at the forefront of the high-tech industry, especially in the health tech sector. The innovative ecosystem along with significant investments in the healthcare sector, both from the public and the private sectors, have enabled Israel to develop a substantial foundation for digital health systems in recent years. Globally, the covid-19 pandemic dramatically demonstrated the necessity of agile, ever-developing healthcare solutions; Israel’s healthcare industry made considerable investments to follow suit.

Israel’s vision for digital health is illustrated by the Israeli Ministry of Health’s short and long-term plans to develop and expand the country’s health tech infrastructure. In order to cope with the challenges of the 21st century, while leveraging the innovative health tech ecosystem, the Israeli healthcare system is focusing on promoting sustainable and advanced digital health tools, that will leverage cutting-edge technologies. That in turn will benefit not only the wellbeing of Israelis but of the entire world.

Furthermore, the Government of Israel acknowledges the importance of data-centric projects. Additionally, the structure of the Israeli healthcare system allows access and usage of country-wide data on a level that many other Western countries are not capable of. An example of the opportunities that arise from these advantages can be seen in the Mosaic Project. The Government of Israel has recently launched the project with the objective of removing regulatory and infrastructure barriers hindering collaboration between health data-centric sectors. The genomic clinical database will promote research and development of personalized medicine products. According to its plans, the Ministry of Health forecasts that by 2030, big-data and advanced data analysis tools will be implemented in the therapeutic environment throughout the healthcare chain.

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. In addition, the MoH announced shifting hospital care to homecare when possible. This shift will continue increasing the demand for affordable products and for products that help patients monitor their own health at home. 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.

Private Health Spending

In 2022, the proportion of private financing in national health spending in Israel was 33.9%, 42.3% of the national expenditure on health were funded by the state’s yearly budget, and 22.5% by health tax funds. 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 significantly 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 approval. 

*Per 1,000 capita

Source: The Knesset Research and Information Center

Source: Israel Central Bureau of Statistics

Registration Process

The MoH has both a regulatory and policy-making role. U.S. companies interested in exporting medical devices or pharmaceuticals to Israel need to partner with 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 wait time 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. In recent years, Israel has launched reforms with the goal of aligning the Israeli standards with international standards, mostly European standards, whenever possible. It is important to note that these reforms are an ongoing process and may take years to implement so discrepancies between local and international regulations are to be expected. 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 ‘health service basket’ , includes all the services, medications, supplies and medical equipment that the insured is entitled to under the National Health Insurance Law. The benefits included in the basket were originally determined based on the health services that were provided by the Ministry of Health and Israel’s leading HMO, Clalit Healthcare Services, as of January 1, 1994. Since then, the list is being updated every year by the Ministry of Health, based on recommendations of a professional committee.

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

• Diagnosis, consultation and medical treatment;
• Certain medications based on the committee’s recommendations and the community’s needs;
• Hospitalization in a general hospital;
• Rehabilitation, including hospitalization;
• Accessories and medical supplies; and
• Medical services in the work place. 

Leading Sub-Sectors

Digital Health

Israel has an excellent digital health ecosystem and is considered one of the global leaders is many sub-sectors. The growing digital health sector in Israel presents many opportunities for American developers in several sub-sectors. For example, Tel Aviv Sourasky Medical Center (Ichilov Hospital), the largest teaching hospital and the second-largest hospital complex in Israel, has implemented leading digital health solution in its facilities, with the objective to streamline the care and ease patients’ experience. As part of the hospital’s efforts, its team is looking for further advanced solutions. Additionally, Israel’s largest HMO, Clalit Healthcare Services, has an open call for proposals for tech companies and startups developing products and services that align with Clalit’s goal to provide state-of-the-art service to its patients. These proposals can be from a wide range of sub-sectors.

Medical Devices

Medical devices have traditionally been the leading healthcare sub-sector in Israel, both for local developers and for foreign exporters, and it accounts for approximately half of the total healthcare industry market share. The medical devices market size (as of 2021) is $1.6 billion, with a compound annual growth rate (CAGR) (2022-2028) of about 2%. The prominent segments of medical devices in the market are cardiovascular devices, hospital supplies, orthopedic devices, neurology devices, general surgery devices, minimally invasive surgical instruments and technologies integrated with imaging capabilities, dental instruments, equipment and technologies for pain management, physiotherapy, ozone & oxygen therapy. Following the global trend, medical devices in Israel is developing towards digital innovation, integrated IT capabilities for better accuracy, focus on tools improving physician-patient interface.

Opportunities

In additional to the opportunities in the digital health and medical devices mentioned above, the Israeli government has recently announced a decades-long strategy of developing the country’s healthcare services, including building eight new hospitals and 19 geriatric centers by 2048. These initiatives can present opportunities for American companies of a variety of sun-sectors: smart hospitals, imaging systems, CRM systems, training and management tools, and more.

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 Inbar Marom at Inbar.Marom@trade.gov .  

Resources

Israel Central Bureau of Statistics www.cbs.gov.il 

Ministry of Health

Ministry of Finance Government Procurement Administration 

The Knesset Research and Information Center

Taub Center for Social Policy Studies