Press Release

IDI's 2020 Democracy Index: Trust in HMOs is Higher Than All Other Public Institutions

Israeli Democracy Index 2020 included a focus on Israel’s healthcare system and found higher levels of satisfaction with HMOs than with hospitals and public trust in HMOs is higher than in any other public institution surveyed

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Yohanan Plesner, President of the Israel Democracy Institute, and Prof. Tamar Hermann, Director of IDI's Viterbi Family Center for Public Opinion and Policy Research, today (Monday) presented President Reuven (Ruvi) Rivlin with the Israeli Democracy Index for 2020. The Index, which is published annually for the past 18 years, reveals a complex picture regarding the level of public trust in key institutions, and in Israelis' confidence in the overall strength and resilience of Israeli democracy.

Prof. Tamar Hermann, Director of the Viterbi Family Center for Public Opinion and Policy Research at the Israel Democracy Institute: "The incredible efforts displayed by the health system during the COVID crisis has earned it the high regard of the Israeli public. An important finding emerging from the Democracy Index is that an absolute majority of the public, supports increasing the health budget, at the expense of budgets for other needs. However, Israelis do not support a higher health tax, most likely due to their general lack of trust in the political system. An additional important finding reveals the high level of satisfaction among Arab Israelis in the public health system and the extent of medical care that is provided equally to all."

In light of the immense impact of the coronavirus pandemic on Israeli society, the survey was conducted both in June, and again in October, to re-examine some of the survey questions and identify trends over time. On these questions, findings from both June and October are presented.

Main Findings:

Comparison between June and October data:

Performance ratings of Israel’s healthcare system
Between June and October, there was a modest decline in the public's ratings of the healthcare system. In June, half (50%) of the total sample rated the system's performance as good or excellent, compared with 42% in October. While for the most part, the scores assigned by the Jewish public remained largely the same (48% gave a positive rating in June, and 46% did so in October), there was a sharp decline in the percentage of positive ratings among the Arab public, from 59% in June to 24% in October.

Satisfaction with HMOs and public hospitals

Fully 83% of the public are satisfied or very satisfied with the quality of medical care provided by their HMO, while only 57% are satisfied or very satisfied with the quality of medical care in public hospitals. A similar picture emerges with regard to the attitude towards patients: 83% are satisfied or very satisfied with the attitude towards patients in their HMO , compared with 52.5% with the attitude in public hospitals.

Satisfied or very satisfied with the quality of medical care and attitude to patients in HMOs and hospitals (total sample, %)

Satisfaction with hospitals is much higher among Arabs than among Jews, both with regard to the quality of medical treatment (74% satisfied or very satisfied versus 54%, respectively) and the attitude towards patients (76% versus 48%, respectively).

Overall, HMOs ranked highest in the level of public trust out of all 11 institutions surveyed in this year's Index, with 78% of respondents expressing trust in their HMO (Jews, 77%; Arabs, 83.5%).

Satisfied or very satisfied with the quality of medical care and attitude to patients, by HMO (total sample, %)

Attitudes toward medical staffs
When asked about an issue that has repeatedly attracted the headlines in Israel—that is, the public's lashing out at medical personnel —a large majority of respondents (76%) did not agree that such behavior is acceptable, though no fewer than 21% expressed some degree of understanding for such outbursts.

The health budget: How large should it be, and where should it go?

There is broad public consensus (86%) on the need to increase the health budget, even if this means cutting back budgets to address other needs. Within the health budget, the public prioritizes the areas to which additional funds should be allocated.

Three most important areas to which additional funds should be allocated if the health budget is increased (total sample, %)

However, despite the broad consensus on the need to increase the health budget, a large majority of Israelis (68%) are opposed to raising the health tax, even if these additional funds would be invested in improving the public healthcare system. Only 29% expressed support for this proposal.

Increased pay for senior doctors and restrictions on private medicine

Almost one-half (49%) of the public believe that senior doctors should receive higher compensation, but be barred from accepting private patients.

Equal treatment

Almost two-thirds of Arab respondents (67%) and more than half of Jewish respondents (55.5%) believe that the public healthcare system in Israel provides equal treatment to patients from all backgrounds and population groups. In the Jewish public, agreement with this statement is more prevalent among those on the Right politically (62%), than among those in the Center or on the Left (48%).

A large majority of the public—96% of Arabs and 71% of Jews—have no preference as to being treated by a Jewish or Arab doctor. However, fully 27% of Jews would prefer to be treated by a Jewish doctor, with the majority of Haredi (ultra-Orthodox) Jews expressing this preference, compared with 16% of secular Jews.


The 2020 Israel Democracy Index is based on a survey conducted by the Israel Democracy Institute's Viterbi Family Center for Public Opinion and Policy Research. In the survey, which was conducted on the internet and by telephone (to supplement the representation of groups that are not sufficiently represented on the network) from June 5-17, 2020 & October 27-29, 2020.1000 men and women were interviewed in Hebrew and 180 in Arabic, constituting a representative national sample of the entire adult population of Israel aged 18 and older. The maximum sampling error for the entire sample was 2.9%± at a confidence level of 95%. The fieldwork was conducted for the June survey by the Midgam Institute (Jews) and the Stat-net Institute (Arabs) and for the October survey by the Midgam Institute. For the full data file see: Data Israel