Israel Journal of Health Policy Research最新文献

{"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}

{"title":"Dental treatments reform for older adults in Israel: the first six years.","authors":"Ayelet Berg-Warman, Shlomo Paul Zusman, Ile Kermel Schifman, Shai Sade, Lena Natapov","doi":"10.1186/s13584-026-00767-y","DOIUrl":"10.1186/s13584-026-00767-y","url":null,"abstract":"<p><strong>Background: </strong>In 2019, a Universal Health Coverage reform of dental services for older adults was implemented in Israel, in order to improve their access to dental care, reduce financial obstacles and decrease inequalities in service utilization. This study aims to examine changes in dental care among elderly over the first 6 years of the reform.</p><p><strong>Methods: </strong>Analysis of the utilization reports submitted by the HMOs to the Ministry of Health between the years 2019 (the beginning of the reform) to 2024. The reports included number of patients treated by type of treatments each year.</p><p><strong>Results: </strong>During the first six years, the number of treated patients in the framework of the reform increased from 46.6 thousand to 129.4 thousand. During the years 2019 to 2024 there was a significant increase in preventive and first aid treatments (2.7 and 2.2-fold, respectively). Maintenance and surgical treatments increased moderately (1.8 and 1.6-fold, respectively),as well as rehabilitative treatments for 80 + age group and check-ups (1.5 and 1.4-fold, respectively).</p><p><strong>Conclusions: </strong>During the first six years of the dental treatment reform, there was a notable increase of older adults who received dental treatments at HMOs clinics.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165124","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":"Insured but unequal: who really utilizes voluntary health insurance in Israel? Evidence from two consecutive cross-sectional studies.","authors":"Ruth Waitzberg, Rina Maoz-Breuer, Ella Katz, Nathan Shuftan","doi":"10.1186/s13584-026-00763-2","DOIUrl":"10.1186/s13584-026-00763-2","url":null,"abstract":"<p><strong>Background: </strong>Financial pressures on health systems have increased in recent years. Voluntary health insurance (VHI) could, in principle, fill in the gaps in public coverage and funding. However, there is little evidence on realized access to VHI-funded care - who uses it and for what services, especially in countries with high VHI ownership, such as Israel. Our study assesses gaps in VHI uptake and utilization across the Israeli population.</p><p><strong>Methods: </strong>Two consecutive cross-sectional data were collected through two national surveys among the adult population (aged 22+) conducted in 2012 and again in 2022, with respective response rates of 61% (N= 2,330) and 52% (N = 2,536). Bivariate analyses (ꭓ²) estimated the differences between population groups in the rates of VHI ownership and utilization of services at least once during the two years preceding the survey, while multivariable logistic regressions estimated the corresponding odds ratios.</p><p><strong>Findings: </strong>VHI ownership rates remained high (around 83%) in both surveys but varied across subgroups. Arabs, residents of peripheral areas, and those in the lowest income quintile had lower ownership rates and lower likelihood of owning it. Overall, VHI self-reported utilization stood at 66% in 2022, lower than 76% in 2012. Visits to specialists were the only service category with increased utilization (from 20% to 28%). In 2022, VHI owners with lower incomes, lower education, and those residing in peripheral areas were also less likely to report utilizing VHI. Yet, Arabs and ultra-Orthodox Jews were more likely to report utilizing VHI. Those reporting poor health were also more likely to report utilizing VHI.</p><p><strong>Discussion and conclusions: </strong>Our study examines VHI ownership trends and gaps in utilization of VHI-funded services in Israeli populations. The regressive nature of VHI premiums and disproportionately higher utilization by owners with higher socioeconomic status highlights the limitations of VHI as a sustainable and equitable financing policy tool for healthcare to policymakers. This unequal coverage demonstrates that VHI is not a full substitute for public funds, potentially indicating access barriers, while showing that fewer insured are benefiting from coverage. Its role should be clearly defined to ensure it complements public healthcare coverage.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057462","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":"Correction: Enhancing medication literacy through a telepharmacy call center in Israel: consultation overview and patient satisfaction.","authors":"Ran Nissan, Rana Cohen, Maria Hurgin, Hen Popilski, Khaleel Zahalka, Merav Ben Natan, Eyal Schwartzberg","doi":"10.1186/s13584-026-00760-5","DOIUrl":"10.1186/s13584-026-00760-5","url":null,"abstract":"","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13195968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148006996","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 implementation of a national registry for international medical volunteers during armed conflict: the Israeli experience.","authors":"Joseph Mendlovic, Tamar Keynan, Adam Cutler, Yoel Collick, Dorit Nitzan","doi":"10.1186/s13584-026-00765-0","DOIUrl":"10.1186/s13584-026-00765-0","url":null,"abstract":"<p><strong>Background: </strong>Israel established the Medical Volunteers for Israel (MVFI) registry to rapidly recruit, license, and integrate international physicians into its health system during emergencies. This study evaluates the registry's design, implementation, and operational outcomes.</p><p><strong>Methods: </strong>A narrative synthesis of registry data was conducted using the MFVI dataset from October 2023 to August 2025. Quantitative analysis characterized physician demographics, specialty distribution, licensing status, and deployment outcomes. A standardized review of hospital needs assessment and licensing protocols was performed to detail the system's replicability.</p><p><strong>Results: </strong>The registry enrolled 7,032 international physicians from over 50 countries, with 59% originating from the United States. High-demand specialties included anesthesiology (23% of deployed), emergency medicine (23%), and trauma surgery (12%). Of those registered, 453 physicians were successfully deployed to fill acute staffing gaps. Deployment occurred through a novel, hospital-specific temporary licensing mechanism that bypassed the traditional multi-month observation requirements for senior physicians entering the Israeli workforce. The process, designed to be efficient and similar to that for temporary licenses for visiting specialists, was intended to accelerate approvals and reduce bureaucracy. Although it was finalized before Oct 7, 2023, for earthquake preparedness, recruitment, and final approval occurred only after that date.</p><p><strong>Conclusions: </strong>The MFVI registry demonstrates that a government-led, need-based integration of international medical personnel is an effective strategy for sustaining healthcare operations during emergencies. While successful in bridging staffing gaps, the model requires robust pre-deployment orientation to overcome language and system barriers. By embedding expertise directly into national infrastructure, this approach offers a scalable alternative to traditional parallel aid models such as emergency medical teams and field hospitals.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13195850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989567","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":"Uncovering unmet needs in healthcare teams: a cross-sectional study on the second victim phenomenon.","authors":"Shani Fisher, Ranit Djerassi, Yulia Gendler, Avinoam Pirogovsky, Jacob Dreiher","doi":"10.1186/s13584-026-00764-1","DOIUrl":"10.1186/s13584-026-00764-1","url":null,"abstract":"<p><strong>Background: </strong>Healthcare teams encounter adverse events and medical errors, and inadequate awareness and support can leave these teams vulnerable as \"second victims\" (SV). The objectives of our study were to assess healthcare professionals' understanding of the SV concept, evaluate the existing support systems in place, and identify the types of support mechanisms they consider most desirable.</p><p><strong>Methods: </strong>In February 2024, the SV Experience and Support online survey was administered to healthcare workers in hospitals owned by Clalit Health Services, Israel. The survey focused on emotional responses following involvement in medical errors, perceived support from supervisors, and the availability of organizational resources. Statistical analysis was performed using SPSS statistical software. A Likert scale was used, where 1 represented \"strongly disagree\" and 6 represented \"strongly agree.\"</p><p><strong>Results: </strong>The survey was sent to 6,645 physicians and 11,855 nurses. A total of 483 physicians and 1,359 nurses participated in the survey (7.2% and 11.4% response rate, respectively). Both physicians and nurses reported high emotional stress (Mean scores: 4.89 ± 1.17 and 5.16 ± 1.06, respectively, p < 0.001) and embarrassment (Mean scores: 4.76 ± 1.16 and 4.94 ± 1.22, respectively, p < 0.001) following errors, with a notable desire for peer support (51.6%). Sleep disturbances also highlighted the adverse events' somatic burden and impact (Mean scores: 3.96 ± 1.49 and 4.22 ± 1.50, respectively, p = 0.002). The most desired support path was having a colleague to discuss the event (p < 0.001).</p><p><strong>Conclusions: </strong>Healthcare workers face a significant risk of becoming SV after unexpected medical events, and peer support is preferred. Program directors should therefore prioritize structured peer support initiatives, alongside robust formal systems and open communication, in accordance with workers' preferences. Addressing gaps in resource awareness and refining managerial approaches is essential.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13188354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976362","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":"Decision fatigue among military primary care physicians: a retrospective study.","authors":"Shir Gutman, Dana Eskenazi Anoshi, Hadasa Sharshevsky, Barak Gordon","doi":"10.1186/s13584-026-00757-0","DOIUrl":"10.1186/s13584-026-00757-0","url":null,"abstract":"<p><strong>Background: </strong>Decision fatigue, based on Baumeister's \"Strength Model of Self-Control\", suggests that the quality of decision-making declines with the accumulation of decisions over time. This phenomenon, previously observed in various professional fields, may impact military physicians who make critical and organizational decisions. We aimed to assess how decision-making changes throughout the workday among military physicians in a clinic setting.</p><p><strong>Methods: </strong>A retrospective observational analysis was conducted using a database of 2 million medical encounters from the military medical record system between 2015 and 2019. Decision outcomes were tracked for exemptions from specific duties granted, sick leave issued, days of sick leave, emergency department referrals, antibiotic prescriptions for upper respiratory tract infections and spinal X-ray referrals for low back pain - in accordance with appointment time and physician employment type.</p><p><strong>Results: </strong>Findings showed a decrease in specific-duty exemptions granted by physicians until lunchtime, a peak post-lunch and a subsequent decline in the afternoon (p < 0.001). Referrals to the emergency department increased through the morning, dipped post-lunch and rose again by day's end (p < 0.001). Sick leave issuance and the number of days granted both declined as the day progressed, with the steepest decline in the afternoon (p < 0.001). Rates of antibiotic prescription for URTIs and spinal X-ray referrals for LBP did not vary significantly throughout the day. Civilian physicians tended to issue more sick leave, exemptions and referrals than regular duty physicians, though both groups demonstrated similar trends throughout the day.</p><p><strong>Conclusions: </strong>This study highlights the influence of decision fatigue on clinical decision-making among military physicians, showing a time-based decline in granting sick leave and specific-duty exemptions, with an increase in emergency referrals towards the end of the workday. These might have system-wide implications such as overutilization of healthcare, and increased health expenditure. Recognizing and addressing decision fatigue is important to mitigate its effects.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934493","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}