Hospitalizations at Home in Israel, a Retrospective Observational Study

Israel's aging population and demographic growth have driven a surge in hospitalizations, prompting the Ministry of Health to expand community-based care. In 2019, a financial incentive was introduced, special payments to health maintenance organizations (HMOs) for Hospital at Home (HaH) services, implemented in 2020. This study examines changes in the volume and geographic distribution of HaH following this policy. We analyzed retrospective Ministry of Health data on all HaH admissions from 2017-2023, excluding COVID-19 cases. Data included length of stay, referral source (hospital vs. community), patient age, and residence. HMOs reported 70,203 HaH admissions during the study period, increasing from only 8 in 2017 to 33,141 in 2023. Growth was most rapid after the payment policy was introduced. The mean monthly HaH days rose sharply, reaching 2762 in 2023. Over time, the proportion of HaH admissions from central Israel increased, while peripheral areas saw a relative decline. Readmission rates to HaH were low-3% within 1 week, and 8%, 15%, and 23% within 1, 3, and 6 months, respectively. HaH could play a significant role in meeting Israel's growing demand for inpatient care. To maximize its impact, policy efforts should address barriers to expansion, particularly in peripheral regions, and promote more equitable geographic access.