Israel Journal of Health Policy Research最新文献

{"title":"Health insurance literacy in Israel: gaps between knowledge and use in a universal healthcare system.","authors":"Reut Ron, Paula Feder-Bubis, Moriah E Ellen","doi":"10.1186/s13584-026-00759-y","DOIUrl":"10.1186/s13584-026-00759-y","url":null,"abstract":"<p><p>BACKGROUND: Health Insurance Literacy (HIL) is critical for navigating healthcare systems and making informed insurance decisions. In Israel, which has a universal system with voluntary insurance, disparities in HIL may contribute to inequitable access. This study assessed HIL among diverse Israeli groups using a validated, culturally adapted, multidimensional tool. METHODS: A nationally stratified sample of Hebrew-speaking and Arabic-speaking Israeli adults (1,012) completed an online cross-sectional survey in September 2024. A 75-item questionnaire combined an adapted Health Insurance Literacy Measure (HILM), self-reported assessments, and objective knowledge tests. Analyses (ANOVA, regression) examined relationships between demographics and HIL dimensions. RESULTS: HIL levels were moderate (mean HILM score: 2.39/4), with significant disparities across demographic groups. Non-Ultra-Orthodox Israeli-born Jews showed the highest literacy, while Arab and foreign-born Jews displayed lower comprehension. Key predictors included income, self-reported health, and insurance type (p < 0.001), while education was weaker than expected. CONCLUSIONS: Findings highlight systemic and cultural barriers to HIL in Israel and the need for targeted educational interventions, simplified communication tools, and culturally tailored programs. This study offers a framework for evaluating HIL in publicly funded systems and insights for other multicultural settings. </p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13085595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692928","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":"Privatization of ophthalmology: unveiling disparities in the surgical arena.","authors":"Asaf Israeli, Keren Hod, Rachel Shemesh, Tamara Wygnanski-Jaffe, Eedy Mezer","doi":"10.1186/s13584-026-00756-1","DOIUrl":"10.1186/s13584-026-00756-1","url":null,"abstract":"<p><p>PURPOSE: To analyze the characteristics and trends of ophthalmic surgeries in public and private hospitals, as well as sex-disparities. METHODS: A nationwide multicenter retrospective observational trend study encompassing surgeries in 9 different hospitals from 2017 to 2022. The retrieved data, which produced an anonymized database, was further divided into sub-specialties, before implementing descriptive and trend analyses. RESULTS: A total of 97,325 surgeries were analyzed. Private hospitals had a higher female predominance (p < 0.001). A slight non-significant increase was noted in private hospitals over the years (0.9% annual increase, p = 0.07). Cataract and oculoplastic surgeries were the most common procedures in both domains. In private hospitals, male predominance was noted in cataract, glaucoma, corneal, retinal, and strabismus surgeries, whereas female predominance was noted in oculoplastic surgeries (p < 0.001 for each). In public hospitals, however, male predominance was only observed in glaucoma, corneal, and retinal surgeries, and female predominance was observed in cataract surgeries (p < 0.001 for each). CONCLUSION: Privatization seems to be an increasing trend in ophthalmology as well, and cream skimming is not as prevalent in this cohort. Sex differences were evident in both the public and private domains in different sub-types of eye surgery. </p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628928","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":"Determinants, patterns, and gaps in patient safety and quality of care research in Israel: a scoping review.","authors":"Merav Ben Natan","doi":"10.1186/s13584-026-00749-0","DOIUrl":"10.1186/s13584-026-00749-0","url":null,"abstract":"<p><p>BACKGROUND: Patient safety and healthcare quality are central priorities, yet preventable harm persists across health systems. Although Israel has implemented quality indicators, safety-culture initiatives and system-level reforms, the national evidence base has never been systematically reviewed. This scoping review aimed to map the extent, range and nature of empirical patient-safety and healthcare-quality research conducted in Israel between 2015 and 2025. METHODS: The review followed JBI and PRISMA-ScR guidelines, with a protocol registered on the Open Science Framework. Systematic searches were conducted in MEDLINE, CINAHL, PubMed and Scopus to identify empirical studies examining patient safety or healthcare quality within the Israeli health system. Eligible studies were charted by design, setting, population, methods and thematic domain, and findings were synthesised narratively. RESULTS: Twenty-eight studies met inclusion criteria, reflecting six thematic domains: organisational culture and reporting behaviour; medication and clinical-process safety; national quality-indicator performance; simulation and accreditation; ethics and patient rights; and crisis preparedness and resilience. Most studies were hospital-based and cross-sectional, drawing heavily on national indicators, structured safety-culture tools and simulation-based methods. Major gaps included limited research in community, mental-health, rehabilitation and long-term care settings, minimal use of interventional or longitudinal designs and scarce inclusion of patient or family perspectives. The evidence base remained predominantly focused on acute-care environments, with little attention to primary care or the wider care continuum. CONCLUSIONS: Israel has a growing but uneven published evidence base in patient safety and healthcare quality, characterised by strong hospital-focused research and comparatively limited representation of community and long-term care sectors in the peer-reviewed literature, even though national safety initiatives and monitoring frameworks operate across these settings. Advancing the field requires expanding research into under-examined settings, diversifying methodological approaches and more fully integrating patient perspectives. The findings provide an essential foundation for national improvement efforts and contribute to global discourse on patient-safety and quality advancement. </p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610461","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":"When practice outpaces policy: Whatsapp use among nursing and medical staff in Israeli hospitals.","authors":"Drora Ben Michael Vinker, Maya Peled-Raz","doi":"10.1186/s13584-026-00754-3","DOIUrl":"10.1186/s13584-026-00754-3","url":null,"abstract":"&lt;p&gt;&lt;p&gt;BACKGROUND AND OBJECTIVES: WhatsApp has become a central communication tool among medical and nursing staff worldwide, offering a fast and convenient way to share clinical information. However, its widespread use raises concerns regarding patient confidentiality and data security. This study examined the extent and characteristics of WhatsApp use for clinical purposes among hospital-based healthcare professionals in Israel, and the perceived risks and benefits associated with its use. METHODS: A quantitative cross-sectional study was conducted using a structured questionnaire adapted from De Benedictis et al., among 283 participants – 132 medical staff and 151 nursing staff – from hospitals across Israel. The questionnaire assessed usage patterns, perceived utility, and perceived risk. Data were analyzed using hierarchical regression to identify predictors of use. RESULTS: Professional WhatsApp use was nearly universal (reported by 100% of physicians and 97.4% of nurses). Physicians reported significantly higher use in both non-identifiable data sharing (mean 3.46 on a 1–5 scale, with 1 = strongly disagree, 5 = strongly agree) and identifiable data sharing (mean 2.61) compared to nurses (means 2.96 and 2.26, respectively). Perceived personal benefit was high (mean 5.19 on a 1–7 scale, with 1 = strongly disagree, 7 = strongly agree), while perceived organizational support was low (mean 1.86), indicating a lack of official guidelines. Regression analysis identified four predictors: age (negative association), and personal, normative-organizational, and regulatory-organizational benefits (positive associations). Perceived risk was higher among women and negatively predicted use. CONCLUSIONS: WhatsApp is a deeply embedded communication tool in the daily clinical practice of the surveyed medical and nursing staff. This reflects a “normalization of non-compliance”, where the perceived efficiency of WhatsApp overrides regulatory prohibitions. Given its advantages and the current policy ambiguity, there is an urgent need for balanced regulatory guidance that leverages built-in security features, enhances risk awareness, and aligns with real-world practices to ensure both efficiency and patient privacy. WhatsApp is widely used by healthcare professionals to share clinical information quickly and efficiently. Our study found that almost all surveyed physicians and nurses use the app for work-related communication, and that identifiable patient information is often shared, despite formal policies prohibiting it. While hospitals issue guidelines that discourage such use, these have limited impact. In contrast, strong social and professional norms within teams encourage WhatsApp communication, making it an integral part of hospital life. The findings mirror global research showing that the need for fast, accessible communication often overrides institutional restrictions, reflecting a “normalization of non-compliance”. This pattern highlights a universa","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594904","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 framework and best practices of emergency medical teams: lessons learned from Israel's international field hospital response.","authors":"Evan Avraham Alpert, Giora Weiser, Deganit Kobliner-Friedman, Mitchell J Schwaber, Ami Mayo, Reuven Kedar, Nehemia Blumberg, Ofer Merin","doi":"10.1186/s13584-026-00751-6","DOIUrl":"10.1186/s13584-026-00751-6","url":null,"abstract":"<p><p>In 2010, a devastating earthquake struck Haiti, killing over 200,000 and injuring over 250,000. Dozens of countries sent medical teams, with Israel’s being one of the first to arrive. These teams saved lives and salvaged limbs. However, other responses were not as professional, resulting in criticism in the medical community of “Disaster Tourism.” For example, certain physicians attempted to perform procedures or surgeries that they were not certified to perform. There was a call to develop a framework for disaster response. The World Health Organization spearheaded this project by initiating the formation of Foreign Medical Teams, which later became known as Emergency Medical Teams (EMTs). The EMT Initiative involves a vision of saving lives in the context of transparency and global cooperation. It includes an emphasis on safe care, ethical care, and an accountable, coordinated response to disasters. There are three general types of teams, with an additional group of specialized care teams. An EMT-1 is similar to a clinic and open only during the day. An EMT-2 adds operating room and inpatient capabilities. EMT-3 which is the most complex, includes a minimum of 40 inpatient beds, four intensive care unit (ICU) beds, and the capacity to treat 100 outpatients a day. The Israel Defense Forces Field Hospital was the first in the world to be recognized as an EMT-3. The Israeli EMT-3 includes an emergency department, inpatient services, surgical capabilities, and an intensive care unit. Pediatric services, infectious disease care, and women’s health are integral parts of the EMT-3. Logistical and ancillary services also play a key role in the success of the field hospital. The Israeli field hospital responded to recent disasters in Haiti (2010), the Philippines (2013), Nepal (2015), and Turkey (2023). The main lesson learned is that the success of the Israeli EMT-3 is based on professionalism and flexibility within the framework of the EMT initiative. The staff consists of highly trained professionals, including board-certified physicians and nurse specialists who convert their everyday skills into those used in the disaster setting. Flexibility includes having these professionals take on logistical responsibilites. Operational flexibility includes the last-minute decision to implement a hybrid versus a standalone model, to using local supplies to quickly adapt to an urgent need. While the lessons here are from the perspective of an EMT-3, they can be applied to other response teams to improve outcomes for disaster victims throughout the world.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13014817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515632","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":"Who benefits from multidisciplinary care in functional somatic disorders? Identifying cost-effective patient selection through diagnostic classification groups.","authors":"Oded Hammerman, Alon Rasooly, Dan Greenberg, Talma Kushnir, Erez Yaakobi, Yacov Ezra","doi":"10.1186/s13584-026-00750-7","DOIUrl":"10.1186/s13584-026-00750-7","url":null,"abstract":"<p><strong>Background: </strong>Functional Somatic Disorders (FSD) significantly impact patients' quality of life while placing a substantial economic burden on healthcare systems. Identifying which patients achieve reductions in healthcare costs through multidisciplinary care remains crucial for optimizing resource allocation.</p><p><strong>Methods: </strong>A retrospective analysis examined healthcare utilization and costs during the year preceding and the year following patients' initiation of treatment at a specialized, multidisciplinary clinic in Israel. The clinic combined medical care with mind-body therapies - including cognitive behavioral therapy, hypnotherapy, and physiotherapy. Using baseline characteristics, patients were divided into Diagnostic Classification Groups (DCG). A multivariable analysis was performed to ascertain the impact of DCG on annual, average changes in healthcare utilization and costs after treatment.</p><p><strong>Results: </strong>Data from N = 685 patients were analyzed. Reduced healthcare utilization and costs were observed among approximately 56% of the population receiving multidisciplinary care. Mean annual cost reductions were 1,367 ILS per patient. Specifically, significant reductions were observed in hospitalizations (-1,723 ILS) and diagnostic procedures (-495 ILS). Patients with simple FSD and stress-exacerbated diseases showed significant cost reductions (P < 0.05), while those with organic disease or difficult FSD did not demonstrate significant changes. Analysis by DCG revealed that baseline diagnostic classification significantly predicted cost reduction.</p><p><strong>Conclusion: </strong>Healthcare utilization and costs were reduced among FSD patients receiving multidisciplinary treatment, with outcomes varying by diagnostic classification. Baseline diagnostic classification reliably predicted treatment cost-effectiveness, underlining the economic value of collaborative care for patients with simple functional disorders and stress-exacerbated diseases. These diagnostic patterns provide healthcare policymakers with selection criteria for multidisciplinary programs and inform the development of tailored interventions.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12997945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475686","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":"Premature mortality and years of life lost attributable to ambient air pollution in Israel, compared to Europe: analysis and implications.","authors":"Ilan Levy, Itamar Grotto, Hagai Levine, Isabella Karakis","doi":"10.1186/s13584-026-00753-4","DOIUrl":"10.1186/s13584-026-00753-4","url":null,"abstract":"<p><p>Exposure to air pollution is considered the most significant environmental risk factor to human health. Updates in epidemiological studies in recent years provided the scientific evidence for the World Health Organization (WHO)’s air quality guidelines in 2021, allowing an update to the quantitative calculation of premature death (PD) from air pollution. This study examines the impact of air pollution on public health in Israel, focusing on PD and years of life lost (YLL) associated with exposure to PM2.5, nitrogen dioxide (NO2), and ozone (O3) and compares them to findings from 41 European countries. Applying the latest WHO air quality guidelines and incorporating census tract level demographic with age and gender separation, the study reveals the significant burden of air pollution in Israel. Between 2015 and 2023, a total of 4,461–6,166 PD per year are calculated from ambient exposure to the three pollutants, and the number of YLL ranges between 46,216 − 65,289 per year. PD and YLL are higher for males compared to females for most age groups except for 85 and over and infants under 1 year. An increase in PD and YLL is seen with age, except for infants under 1 year having the highest YLL. Israel experiences lower rates of PD and YLL compared to European nations with similar pollutant concentrations. This difference is largely attributed to Israel’s younger population. The findings underscore the importance of continued air quality improvements to protect public health in Israel.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12969856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379012","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":"Reimagining Israel's food system: balancing mediterranean diet recommendations with national food security, sovereignty and resilience.","authors":"Ella Berkovich, Stav Shapira, Moran Koren, Nimrod Talmon, Dorit Nitzan","doi":"10.1186/s13584-026-00748-1","DOIUrl":"10.1186/s13584-026-00748-1","url":null,"abstract":"<p><strong>Background: </strong>This study examines Israel's food system's security, sovereignty, resilience, and sustainability using the Mediterranean Diet (MD) lens. The current global context, marked by supply chain disruptions, climate change impacts, and geopolitical tensions, highlights the critical importance of resilient food systems. We analyzed Israel's food system using FAO Food Balance Sheets (FBS) (2010-2020 trends) and Israel Central Bureau of Statistics (CBS) production and trade data (2021) to assess food availability, import dependency ratios (IDR), and alignment with Mediterranean Diet guidelines.</p><p><strong>Methods: </strong>A literature search was conducted using PubMed, Semantic Scholar, EBSCO Discovery, and Google Scholar, aiming to agree on the food-based guidelines of MD and their impact on health outcomes. Studies from the past 10 years with the keywords \"Mediterranean diet\" and \"meta-analysis\" were included. The Israeli agricultural production data from 2010 to 2020 were drawn from the Central Bureau of Statistics (CBS). Import dependence was calculated by converting product quantities from tonnes to grams per person per day (annual quantity × 10 million people ÷ 365 days).</p><p><strong>Results: </strong>Israel demonstrates significant import dependency across critical food groups, with 90% of cereals, 87% of fish, 82% of nuts, and 65% of added fats sourced internationally. While nearly self-sufficient in poultry and dairy, chickens and cows grown in Israel depend on imported feed. Moreover, the country's food supply significantly deviates from the MD recommendations. Notably, there is an undersupply of nature-based proteins, including legumes.</p><p><strong>Conclusion: </strong>The results emphasize the advantages of shifting towards more locally produced, plant-based food and feed, especially in nature-based proteins. Embracing an MD-aligned food system would concurrently tackle the challenges of public health, food security, resilience, and environmental sustainability. These findings hold global significance for countries confronting similar issues in reconciling nutritional recommendations with food security needs. Future strategies should concentrate on policy reforms, agricultural investments, and public involvement to strengthen Israel's food sovereignty and nutritional landscape.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12964903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366867","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":"Individual causal attribution in occupational disease claims: a structured epidemiological approach.","authors":"Eytan Ellenberg, Marc Weber, Aviram Weiss, Eldad Katorza, Akshaya Bhagavathula","doi":"10.1186/s13584-026-00752-5","DOIUrl":"10.1186/s13584-026-00752-5","url":null,"abstract":"<p><p>The determination of whether occupational exposure contributed to disease in an individual worker is a key element in occupational disease adjudication, particularly within public insurance systems such as that of Israel. At present, such assessments often rely on expert judgment grounded in clinical intuition rather than on structured, reproducible inference.This paper proposes a structured epidemiological approach to individual causal attribution, integrating population-based evidence with case-specific analysis. The framework is organised into four analytical stages: appraisal of causal capacity, quantitative estimation of association, individualised causal partitioning, and probabilistic legal interpretation.Israel’s hybrid medico-legal system offers a suitable setting for piloting this approach. Embedding structured epidemiological reasoning into occupational disease adjudication may enhance transparency, scientific integrity, and consistency, thereby strengthening fairness and public trust in compensation decisions.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12947422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147311112","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":"Managing healthcare for female BRCA carriers in the population screening era: developing a harmonized national policy for surveillance and risk-reduction.","authors":"Rachel Michaelson-Cohen, Shunit Armon, Naama Srebnik, Einat Koller Volkow, Pnina Mor, David Gekhtman, Ora Rosengarten, Adi Maisel Lotan, Hadar Goldvaser, Yahelli Miller, Dana Madorsky Feldman, Rinat Bernstein Molho, Miri Sklair Levy, Inbal Kedar, Yael Goldberg, Yael Raz, Sharon Simchoni, Aviad Hoffman, Miora Linial, Einat Carmon, Inbar Gatot, Michal Braha, Rakefet Chen Shtoyerman, Shikma Mordechai, Elizabeth E Half, Lior Katz, Zohar Levi, Sharon Bratman Morag, Tanir M Allweis, Eitan Friedman, Ephrat Levy-Lahad, Sari Lieberman","doi":"10.1186/s13584-026-00746-3","DOIUrl":"10.1186/s13584-026-00746-3","url":null,"abstract":"<p><p>BACKGROUND: The implementation of Israeli National screening for BRCA1/BRCA2 pathogenic variants (PVs) in 2020 has led to a significant increase in the number of unaffected female carriers who are referred to high-risk surveillance clinics (HRSCs). Lack of standardization in protocols for risk reduction and surveillance between HRSCs results in confusion and gaps in care. We aimed to identify discrepancies in existing practices and lead to policy development of a national policy for surveillance, management and risk reducing strategies in BRCA-PV carriers. METHODS: A comparative analysis of risk reduction and surveillance protocols of the nine leading HRSCs across Israel, comprising the Israeli Consortium for hereditary breast and ovarian cancer (HBOC), and multi-center meetings to develop consensus guidelines for HRSCs. RESULTS: Our analysis revealed a high level of prior consensus on critical aspects including risk-reducing mastectomy, salpingo-oophorectomy, fertility treatment, contraception, hormone replacement therapy, and general health behavior. For breast cancer (BC) imaging surveillance there was variability regarding frequency (e.g. only one HRSC offers biannual MRI for BRCA1 carriers), age limits (five centers continue in women older than 75 years), frequency during pregnancy and lactation (four HRSCs every three months and four others every six months; one does not recommend any surveillance), and surveillance post-mastectomy. For ovarian cancer (OvCa) surveillance, there was also variability: six centers recommend biannual/annual serum CA-125 level and pelvic sonography for all women, one center recommends this for all women till risk-reducing-bilateral-salpingo-oophorectomy (RRBSO), and two centers exclusively for women from age 35 till RRBSO. Surveillance recommendations for malignancies other than BC and OvCa differed greatly among centers. </p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":"4"},"PeriodicalIF":2.4,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087516","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}