Israel Journal of Health Policy Research最新文献

{"title":"Pitfalls encountered while projecting the future Israeli anesthesiologist workforce: lessons from the Israel anesthesiologist workforce study.","authors":"Ariel Wimpfheimer, Yehuda Ginosar, Daniela Quesada, Shai Fein, Charles Weissman","doi":"10.1186/s13584-026-00780-1","DOIUrl":"10.1186/s13584-026-00780-1","url":null,"abstract":"<p><strong>Background: </strong>The smooth and efficient operation of a country's healthcare system is highly dependent on the size and specialty composition of its physician workforce. Therefore, it is incumbent upon a country's healthcare leadership to continually examine the workforce situation in each medical specialty, especially critical specialties like anesthesiology, so as to detect issues that could lead to shortfalls and surpluses and then apply effective corrective actions. The aim was to assess the accuracy of the different predictive methods and identify possible ways of improving their predictive capabilities. Our assumption was that the accuracy of workforce predictions is primarily affected by unforeseen and disruptive events.</p><p><strong>Methods: </strong>Cross-sectional surveys of the Israeli anesthesiology workforce were performed in 2005 (n = 711 anesthesiologists) and 2021 (n = 1330 anesthesiologists). This permitted comparing needs and demand-based workforce forecasts made in 2005 with the actual 2021 workforce. Reasons for discrepancies between the 2005 forecasts and the reality in 2021 were sought.</p><p><strong>Results: </strong>The 2005 needs-based projections underestimated the actual increase in anesthesiologists because the population grew at a rate faster than that estimated in 2005. Furthermore, there was an increase in the proportion of the population > 65 years old, an increase in life expectancy and a higher birth rate requiring a greater number of caesarean sections and epidural catheter insertions. Moreover, the 2011 union contract between the government and the Israel Medical Association increased anesthesiologist vacation time by two weeks per year. The demand-based projection underestimations were attributed to the significant increase in anesthetics performed outside operating rooms, such as, in cardiac catheterization laboratories and invasive radiology and endoscopy suites. Comparing anesthesiologist workforce projections made in 2005 to the workforce realities 16 years later revealed that many unpredictable (greater population growth) and disruptive (union contract) factors that ensued during that time period led to underestimating future workforce needs.</p><p><strong>Conclusions: </strong>Forecasting the future Israeli physician anesthesiologist workforce is an endeavor fraught with unpredictable challenges. To facilitate frequently updated forecasts of future workforce needs, healthcare systems require robust, long-term forecasting capabilities that use near real-time data obtained from the ubiquitous electronic medical and hospital record systems. These data should then be entered into sophisticated data analytic tools, rather than simple needs and demand-based methods. Such up-to-date forecasts should help healthcare system leaders and policy makers make more informed workforce decisions.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National adverse event reporting for medical devices in Israel, 2013-2024.","authors":"Meital Mishali, Nadav Sheffer, Maya Negev","doi":"10.1186/s13584-026-00776-x","DOIUrl":"10.1186/s13584-026-00776-x","url":null,"abstract":"<p><strong>Background: </strong>Post-market surveillance systems are essential for identifying medical device-related adverse events and ensuring patient safety. In Israel, the Ministry of Health has operated a national medical device reporting system for decades. The system is modeled on United States and European regulatory frameworks, although the Medical Devices Act has not yet entered into force.</p><p><strong>Methods: </strong>Following formal approval, anonymized aggregate data were obtained from the Ministry of Health Medical Device Division for reports submitted between 2013 and 2024. The dataset included annual reporting volumes, report classification as adverse events or Field Safety Notices, reporting source, and event type (death, injury, or malfunction), where available. Availability varied across the study period; analyses were therefore restricted to years in which the relevant variables were recorded.</p><p><strong>Results: </strong>Overall reporting volumes increased over time, from 406 in 2013 to 874 in 2024. Non-linear trends were observed, with declines in 2017, 2020, 2022, and 2024. Since 2019, adverse events accounted for approximately 61.9-75.5% of reports annually, while Field Safety Notices comprised 21.4-33.3%. From 2022 onward, most adverse events were classified as injuries, increasing from 87.1% in 2022 to 89.8% in 2023 and remaining high at 89.1% in 2024. Malfunctions accounted for 10.3% of adverse events in 2022, 7.9% in 2023, and 8.5% in 2024, whereas deaths remained relatively stable at 2.2-2.5%. Reporting was dominated by registration holders (70-80%), primarily importers and distributors, followed by manufacturers, with consistently limited contributions from healthcare institutions and voluntary reporters.</p><p><strong>Conclusions: </strong>This analysis of Israel's national medical device reporting database provides an empirical baseline for assessing the structure and functioning of the country's post-market surveillance system. Increasing reporting activity and improved event classification indicate system maturation. The predominance of reports from registration holders, alongside more limited participation by healthcare institutions and voluntary reporters, points to areas for continued development. The following measures would strengthen post-market surveillance in Israel: full implementation of the legal framework; clearer reporting responsibilities and pathways: targeted guidance and training; electronic reporting and analytical tools; improved event documentation; and structured feedback and transparency mechanisms.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extending geriatric care beyond traditional settings: lessons from a mobile assessment program.","authors":"Zorian Radomyslsky, Dor Atias, Bar Cohen, Ali Abu-Raya, Sara Kivity, Reuma Kurz, Eduardo Schejter, Jacob Segal, Ilan Yehoshua, Ori Liran, Miri Mizrahi Reuveni, Galit Kaufman, Daniela Rahamim-Cohen, Limor Adler","doi":"10.1186/s13584-026-00775-y","DOIUrl":"10.1186/s13584-026-00775-y","url":null,"abstract":"<p><strong>Background: </strong>As populations age, changing living conditions and declining self-advocacy often create barriers to essential care. Mobile Geriatric Teams (MGTs) offer a potential solution by providing assessments within a patient's regular environment, potentially reaching underdiagnosed and undertreated individuals who struggle to access routine healthcare. The aim of this study was to evaluate the clinical impact and reach of MGTs in the Northern District of Israel. Specifically, we aimed to assess the extent of MGT-initiated Comprehensive Geriatric Assessments and compare therapeutic and diagnostic outcomes between patients seen by MGTs and those receiving standard community-based geriatric consultations.</p><p><strong>Methods: </strong>This is a retrospective, data-based study serving as a proof-of-concept evaluation for MGT implementation in Israel. The intervention was implemented in MHS between January 1, 2020, and December 31, 2023, and data were collected 3 and 6 months after the MGT appointment. Group comparisons were conducted using chi-square tests, Fisher's exact tests, and Wilcoxon rank-sum tests. In addition, we performed matched logistic regression models.</p><p><strong>Results: </strong>A total of 8,152 individuals were included in the study; 4,348 were assessed by MGTs. The MGT group participants were slightly older and had a higher proportion of males and a lower SES category than the comparison group. The MGTs group had fewer diagnoses of mild cognitive impairment, dementia, and depression, compared to the comparison group. They also had more diagnoses of orthostatic hypotension, and they were more likely to be assessed for fall risk. The MGT group was also prescribed fewer medications in the months following the assessment. After the MGT intervention, we report an increase in primary care visits in the relevant population in the district where it was implemented, while the comparison group did not have a corresponding trend.</p><p><strong>Conclusions: </strong>In this study, we demonstrated that MGTs can reach a specific subpopulation of the elderly who might not otherwise undergo a geriatric assessment, primarily males, those of low SES, and possibly those with less urgent health concerns. These findings highlight the complementary role of MGTs in increasing accessibility, promoting equity, and addressing unmet needs in populations less likely to seek care on their own.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of forensic and legal systems in suicide prevention: Implications for Israeli healthcare policy.","authors":"Gadi Lubin, Liat Keysar Gersht, Ligat Shalev","doi":"10.1186/s13584-026-00773-0","DOIUrl":"10.1186/s13584-026-00773-0","url":null,"abstract":"<p><strong>Background: </strong>Suicide is a leading cause of death among young people worldwide and remains a significant cause of mortality across all age groups, especially in older adults. The underlying causes of suicide span various disciplines and are deeply influenced by societal attitudes, which fluctuate between glorification and severe condemnation of suicide. This study aims to evaluate the role of court rulings on suicidal behavior, with particular attention to implications for healthcare policy in Israel.</p><p><strong>Methods: </strong>We searched the national court rulings databases for alleged psychiatry malpractice in suicide-related cases and of pre-trial settlements from 1985 to 2023. For court decisions, we collected patients' socio-demographic and clinical characteristics, lawsuit characteristics, and the quality of medical documentation and decision-making processes. For pre-trial settlements, we collected data about lawsuit characteristics. Two researchers reviewed the qualitative data, while the quantitative data was analyzed with descriptive statistics.</p><p><strong>Results: </strong>Over the 38-year period, there were 20 psychiatry malpractice court lawsuits related to patient suicides, including 17 deaths and 3 life threatening attempts. Of these, 12 (60%) of cases were won by the plaintiff, and eight (40%) by the defendant. In 14 cases, the suicides occurred in inpatient units and in six cases in community settings. The number of lawsuits notably increased over time for suicide events, with 17 pre-court settlements between 1985 and 1997, and 56 cases in each of the subsequent periods (1998-2010 and 2011-2023).</p><p><strong>Conclusions: </strong>The number of malpractice lawsuits related to suicide in Israel is increasing over time. Our findings, which show a rise in both litigation and pre-trial settlements, may put pressure on psychiatrists to avoid certain kinds of work, especially in the public sector. Such a shift could have broader effects on the quality of suicide prevention efforts and overall mental health care. The study highlights the structural tension between retrospective legal accountability and prospective clinical and public-health approaches to suicide prevention. Addressing this challenge requires balanced policy responses, including strengthening patient-safety and risk-management systems, improving clinical documentation and decision transparency, fostering constructive collaboration between legal and mental health systems, and considering alternative compensation mechanisms that reduce adversarial pressures while supporting affected families.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing organizational resilience of emergency medical services through a designated intervention program.","authors":"Tamir Velner, Zohar Rubinstein, Bruria Adini","doi":"10.1186/s13584-026-00772-1","DOIUrl":"10.1186/s13584-026-00772-1","url":null,"abstract":"<p><strong>Background: </strong>Emergency medical services (EMS) in conflict-affected settings face compounding operational demands, making organizational resilience (OR) a critical institutional asset. Israel's EMS have operated under ongoing security pressures for decades, intensified dramatically following the 7 October 2023 attacks. Despite growing recognition of OR as a measurable and modifiable property, longitudinal interventional evidence in pre-hospital settings remains sparse. This study reports the development and three-time-point evaluation of a targeted intervention program designed to enhance OR within Israeli EMS.</p><p><strong>Methods: </strong>A three-time-point quasi-longitudinal interventional study was conducted within a single EMS: T1 (pre-intervention baseline; n = 196), T2 (post-intervention; n = 205), and T3 (six-month follow-up; n = 172). OR was measured using the validated seven-domain Organizational Resilience Questionnaire (ORQ). The 70-hour intervention - comprising structured training (30 h, 4 weeks) and organizational embedding (40 h, 24 weeks) - was delivered by internal Resilience Trustees. OR changes were examined using one-way ANOVA with Bonferroni-corrected comparisons (Cohen's d) and independent-samples t-tests (α*=0.005). Sequential multivariable regression (pooled n = 573) and ANCOVA identified independent OR predictors and examined OR changes after covariate adjustment.</p><p><strong>Results: </strong>Composite OR increased significantly from T1 to T2 (Δ=+0.20; p = 0.018; d = 0.27), with a Bonferroni-corrected significant gain in situational awareness (Δ=+0.25; p < 0.001), with additional gains in adaptive capacity (Δ=+0.21; p = 0.006) and learning processes (Δ=+0.23; p = 0.006) reaching conventional but not Bonferroni-corrected significance. OR continued to rise at six-month follow-up (T1 mean = 3.86; T2 mean = 4.06; T3 mean = 4.09; Δ T1→T3 = + 0.23; p = 0.007; d = 0.32). The time effect remained significant after full covariate adjustment (ANCOVA: F = 7.41; p = 0.001; ηp²=0.026), with paramedics showing greater gains (+ 0.27) than other staff (+ 0.05; Time × Profession: p = 0.046). Transformational leadership, employee well-being, and technological advancement were the dominant OR predictors (pooled R²=0.770; β = 0.458, 0.274, 0.208, respectively; all p < 0.001).</p><p><strong>Conclusions: </strong>A structured, domain-targeted OR program was associated with significant, domain-coherent resilience gains that progressively consolidated under protracted conflict conditions. The ORQ and the Resilience Trustee model - for which the present study provides preliminary effectiveness evidence - together offer a promising framework for OR strengthening in EMS organizations confronting chronic operational disruption, with implications for national and global emergency health policy.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in developmental milestone attainment among Israeli children between 2019 and 2024.","authors":"Irena Girshovitz, Guy Amit, Inbal Goldshtein, Pinchas Akiva, Dalit Landesman Milo, Deena R Zimmerman, Ravit Baruch, Meital Avgil Tsadok, Yair Sadaka","doi":"10.1186/s13584-026-00771-2","DOIUrl":"10.1186/s13584-026-00771-2","url":null,"abstract":"<p><strong>Background: </strong>Monitoring developmental milestones is essential for identifying at-risk populations and for guiding effective intervention programs. Our previous report examined milestone attainment among Israeli children from 2016 to 2020. Using a similar methodology, this study analyzes trends in developmental milestone attainment in the Israeli population from 2019 to 2024, with primary focus on 2019 to 2023 because of changes in evaluation policy. This follow-up report complements the earlier analysis by providing updated estimates for the post-COVID period and enabling assessment of temporal trends and potential changes in socioeconomic and regional disparities that could not be evaluated previously.</p><p><strong>Methods: </strong>The dataset included over 1 million children with more than 5 million developmental assessments conducted at Maternal and Child Health Clinics (MCHCs) across Israel. These assessments were used to calculate failure rates across four developmental domains: language, social, gross motor, and fine motor skills, along with parental concern about child development. Data were stratified by maternal characteristics, such as age, education, employment, and marital status, and by family sociodemographic factors, including ethnicity, degree of Haredi observance and socioeconomic status. We applied multivariable logistic regression to estimate associations between sociodemographic factors and the odds of failure to attain milestones, while controlling for confounding.</p><p><strong>Results: </strong>A mild overall increase in milestone failure rates was observed from 2019 to 2023. Disparities based on maternal characteristics, particularly lower education, divorce status, unemployment, advanced maternal age, and immigration background, widened notably during periods of national disruption (COVID-19 and the war). In contrast, gaps associated with ethnicity and socioeconomic status remained stable or narrowed. Parental concern increased across most groups, particularly among Bedouin parents, suggesting growing awareness.</p><p><strong>Conclusions: </strong>Maternal-level characteristics were strongly associated with elevated developmental risk from 2019 to 2023, and may be particularly sensitive to national crises. The findings underscore the importance of strengthening parental awareness, prioritizing early identification of high-risk families, and maintaining access to developmental services during emergencies. The study's insights can support decision-makers in education, health, welfare, and local authorities in developing evidence-based strategies to promote equity and resilience in early childhood development systems.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between economic status, poverty, and health among Arabs in Israel.","authors":"Mohammad Khatib","doi":"10.1186/s13584-026-00770-3","DOIUrl":"10.1186/s13584-026-00770-3","url":null,"abstract":"<p><strong>Background: </strong>Arabs in Israel, comprising about 21% of the population, are recognized as an indigenous minority with full citizenship rights, yet they face persistent structural disadvantages compared to Jewish citizens. These disparities are evident across socioeconomic, educational, employment, and health domains. High poverty rates, particularly among women, children, and the older adults, are aggravated by limited governmental investment in infrastructure, education, and health services. Arab women's labor force participation remains notably low due to systemic barriers. Extensive evidence links socioeconomic status with health outcomes and behaviors. This study examines how sociodemographic factors and health knowledge are associated with economic status, self-rated health, and health behaviors among Arabs in Israel.</p><p><strong>Methods: </strong>This cross-sectional study utilized data from the 2015-2016 Health and Environment Survey among Arabs in Israel (HESPI). Employing a three-stage stratified cluster sampling of over 2,000 households, face-to-face interviews gathered socio-demographic, economic, and health-related data. The final sample included 2,041 adults representing diverse socioeconomic and geographic groups within Arab communities.</p><p><strong>Results: </strong>Approximately half of participants lived below the poverty line (51.7%). Those with lower economic status exhibited poorer self-rated health (p<.001, d = 0.22), higher prevalence of chronic illness (p=.009, d = 0.13), and lower engagement in physical activity (p<.001, d = 0.29), while smoking and BMI did not significantly differ by economic status. Family size moderated the relationships between economic status and both chronic illness (p<.001, 95%CI = 1.33, 2.19) and SRH (p<.001, 95%CI = -0.33, -0.13), indicating that smaller families are less likely to experience these negative effects of low economic status. Educational attainment slightly moderated the link between economic status and physical activity (p=.016, η2 = 0.003). Regression analyses revealed that gender, age, education, and health knowledge were significantly associated with health outcomes and behaviors (R² = 0.10 to R² = 0.43), with health knowledge mediating several of these associations.</p><p><strong>Conclusions: </strong>The findings indicate that poverty is associated with poorer health outcomes and behaviors among Arabs in Israel. Smaller family size and higher education may mitigate the negative effects of poverty, and health knowledge plays a mediating role for health outcomes and behaviors. Findings suggest that socioeconomic empowerment and higher education are important in promoting health equity.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How do the incomes of Israeli Arab physicians compare with those of Israeli Jewish physicians?","authors":"Bruce Rosen, Sami Miaari","doi":"10.1186/s13584-026-00769-w","DOIUrl":"10.1186/s13584-026-00769-w","url":null,"abstract":"<p><strong>Background: </strong>In 2023 Israeli Arabs (i.e., Arab Palestinian citizens of Israel) constituted 22% of Israel's working-age population. In that same year, Israeli Arabs constituted 25% of Israel's employed physicians of working age - up significantly from 8% in 2010. The objectives of this study were to: 1) assess whether, and to what extent, there is an Arab-Jewish income differential among Israeli physicians; 2) assess the extent to which any such differential can be attributed to Arab-Jewish differences in the demographic, geographic, and/or work-related characteristics of the medical workforce; and 3) explore the policy implications of the key findings.</p><p><strong>Methods: </strong>The analysis utilized the Central Bureau of Statistics' 2022 Population and Housing Census, which included data on 7,089 physicians, of whom 1,333 were Arab and 5,756 were Jewish or other (hereafter \"Jewish\"). The main income variable examined was \"Total annual gross income from work\".</p><p><strong>Results: </strong>In 2022, the average annual physician income for Arab physicians was 26% less than for Jewish physicians (NIS 358 thousand vs. NIS 483 thousand). Arab physicians were more likely to be under age 40 (71% v. 28%), male (77% v. 52%), residents of the North region (48% v. 7%), in non-supervisory roles (87% v. 75%), and generalists or family practitioners (33% v. 22%). Controlling for age and sex, via regression analysis, reduced the income differential to 1%. This major reduction was due to Arab physicians being markedly younger than Jewish physicians. Further controlling for regional distribution and work characteristics (managerial status, specialty status/type, and months worked) did not change the ethnicity differential, but did markedly reduce the coefficients of the age variables.</p><p><strong>Conclusions: </strong>The 2022 Arab-Jewish income differential among physicians was due predominantly to differences in age composition. The differential could potentially shrink in the decades ahead, as more Arab physicians reach the ages at which physician incomes are at their highest. However, as part of the effect of age on income is mediated by work characteristics, the extent to which the wage gap will shrink will depend in part on the extent to which Arab physicians will secure prestigious residency training slots and managerial positions. Health system leaders can play an important role in promoting such developments. In particular, steps should be taken to increase the representativeness of Arabs in Israeli medical schools.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13292322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key factors influencing medical residency choice among medical graduates.","authors":"Reut Shoham, Mor Vaknin, Yuval Tal, Nevo Yahav, Arnon Afek, Gad Segal, Shalev Fried, Ofira Zloto","doi":"10.1186/s13584-026-00768-x","DOIUrl":"10.1186/s13584-026-00768-x","url":null,"abstract":"<p><strong>Background: </strong>Specialty choice plays a central role in shaping physicians' careers and influences the distribution and sustainability of the healthcare workforce. In Israel, persistent shortages in specific specialties and geographic regions highlight the need to better understand the motivations guiding specialty preferences. Identifying latent motivational dimensions provides a broad perspective on the interplay between multidimensional factors shaping specialty choice.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among Israeli medical students in their final year and medical interns between July 2024 and January 2025. Participants completed an online questionnaire including demographic characteristics and motivational factors influencing specialty choice using 5-point Likert-scale items. Exploratory factor analysis based on polychoric correlations was performed to identify latent motivational dimensions. Factor associations with demographic characteristics and intended specialty were examined using proportional-odds ordinal logistic regression.</p><p><strong>Results: </strong>A total of 527 trainees participated. Exploratory factor analysis identified three motivational dimensions: Interpersonal Factors, Career and Academic Development, and Lifestyle Aspects. All factors demonstrated acceptable internal consistency. No sex-based differences were observed for lifestyle or career and academic motivations, while women rated interpersonal considerations higher than men. Career and academic development motivations were stronger among trainees who studied abroad and among graduates compared with final-year students. Specialty-specific analyses showed that candidates intending surgical or obstetrics and gynecology specialties placed the greatest emphasis on career and academic development, while lifestyle considerations were more prominent among those aiming for pediatrics and psychiatry. Interpersonal motivations did not differ significantly across specialties.</p><p><strong>Conclusions: </strong>Specialty choice among Israeli medical trainees is shaped by distinct but interrelated motivational dimensions with important workforce implications. The shared importance of lifestyle considerations across sexes suggests that improvements in work-life balance may enhance recruitment across a wider range of specialties. Specialty-specific differences in career and academic motivations highlight the potential value of structured exposure during medical school rotations to research activity and academic career pathways, particularly in fields perceived as offering limited academic opportunities. Aligning training environments with trainee motivations may support recruitment to specialties in distress and contribute to long-term workforce sustainability.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13274235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From exception to insight: a phenomenological study of quality managers' perspectives on the individual appeals in the National Healthcare Quality Program.","authors":"Khaled Awawdi, Elena Maoz, Limor Friedensohn, Yifat Erlich-Shoham","doi":"10.1186/s13584-026-00766-z","DOIUrl":"10.1186/s13584-026-00766-z","url":null,"abstract":"<p><strong>Background: </strong>National quality indicators play a crucial role in monitoring hospital performance and fostering accountability. However, standardized indicators often fail to capture the intricate realities of clinical practice. To mitigate this limitation, Israel's National Program for Quality Indicators for general, geriatric, and psychiatric hospitals has implemented an individual appeals process, enabling hospitals to request case-based exclusions from indicator calculations when performance deviations arise from factors beyond their control. After three years of this initiative, our goal is to investigate the experiences of hospital Quality Managers (QMs) with the individual appeals track, aiming to inform enhancements to the national quality indicators program.</p><p><strong>Methods: </strong>A qualitative, phenomenological study was conducted using semi-structured interviews with ten QMs from general, geriatric, and psychiatric hospitals. Interviews were analyzed using thematic, textual, and content analysis.</p><p><strong>Results: </strong>Three core themes emerged: (1) Knowledge and familiarity gaps - most QMs relied on experiential learning rather than formal training or Ministry guidelines; (2) Communication gaps - strong collaboration existed within hospitals and with supervising nurses, but limited dialogue and feedback occurred with higher Ministry levels or across institutions; (3) Recognition gaps - QMs perceived acceptance of appeals as professional validation, while rejections often evoked frustration and a sense of underappreciating.</p><p><strong>Conclusions: </strong>QMs' experiences highlight systemic gaps in training, communication, and recognition that influence the perceived legitimacy and effectiveness of the individual appeals track. Strengthening structured onboarding, establishing transparent two-way communication, and embedding formal recognition mechanisms could enhance motivation, professional confidence, and the program's credibility.</p><p><strong>Policy implications: </strong>Institutionalizing the appeals process as a formal policy tool supported by standardized training, inter-hospital learning forums, and routine feedback loops can transform it from a technical exception mechanism into a strategic platform for continuous quality improvement and policy learning within Israel's healthcare system.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}