Management of Community-Based Home Hospitalization (CBHH) in Israeli Public Health System

Increased utilization of health and hospital services around the world due to growth in aging population has been important for national policies as it affects the allocation of national resources and budgets. Home-based care is one of the solutions for dealing with the growing demand for hospital beds and for reducing the length of hospital stays and their costs, which are derived from institutional hospitalisation. It refers to various services provided in the home to support patients. Home hospitalisation services are gradually becoming part of the standard care in many health systems around the world. Various community-based home hospitalization (CBHH) models have been developed for a wide range of acute, chronic, rehabilitative, and end-of-life medical conditions. Recent studies have reported that CBHH programs carry fewer costs and have greater patient satisfaction compared to equivalent traditional inpatient hospitalizations; however, studies on the organizational aspects of implementing CBHH are scarce. In 2017, a model for CBHH for acute medical conditions was implemented for the first time in Israel at Maccabi Healthcare Services. So far, 779 patients (50% males, average age, 72 years) have been treated within this model, mostly (76%) for infections. Most patients expressed high overall satisfaction with this service, especially in terms of dignity, attitude and care of the professional team. Both patients and physicians perceived that CBHH provides a suitable mental and emotional environment, which also reduces the risk of exposure to infections. The Israeli Ministry of Health has recently decided to provide financial incentives to HMOs that will develop community outpatient models as a substitute for acute and continuing hospitalization in accordance with the established principles.