Perceptions of home hospitalization among the public and physicians in Israel: Findings from surveys conducted for the Dead Sea Health Policy Conference of 2022
Authors: Laron Michal , Nissanholtz-Gannot Rachel , Fialco Sharvit , Hochwald Inbal Halevi , Green Gizell , Offer Itamar , Lavie Gil 
Published: February 2024

Abstract

Background
Hospital at Home (HaH) is an alternative care model that delivers acute hospital-level services in patients’ homes. Despite its proven advantages and the accumulated experience with HaH worldwide, it did not gain a significant foothold in Israel until 2020, during the COVID-19 pandemic. The issue was highlighted at the Dead Sea Conference on Health Policy in 2022. This study examines and compares perceptions of HaH among the Israeli public (potential patients and their families) and among physicians (in the community and in the hospitals), Jewish and Arab, and identifies facilitators and barriers to expanding HaH in Israel.
Methods
Two online cross-sectional surveys were conducted. One survey was answered by 342 physicians, and the other by 424 members of the public aged 35+ recruited on the basis of quota sampling methodology for the variables of age, gender, district of residence, and population group. Descriptive statistics were used to examine perceptions of potential HaH stakeholders and to explore the association between variables, measured on a nominal scale, using chi-square tests. Multivariate relationships were analyzed using logistic regression.
Results
About 39% of the respondents in the survey of the public thought that the quality of care in HaH is as good or better than in the hospital system; 44% thought the safety of care is as good or better in HaH; and 58% thought the communication between patients/families and the healthcare professionals is as good or better in HaH. Physicians expressed greater confidence in HaH than the public; The parallel figures in the survey of physicians were 65%, 75%, and 91%. About 78% of the respondents in the survey of the public and 97% of the respondents in the physicians' survey view HaH as a good alternative to hospitalization and similar proportions would be interested in personally using HaH if offered to them or their families instead of traditional hospitalization.
In the survey of the public, A lower proportion of Arab respondents and of respondents with income lower than average had a positive view of HaH than Jewish respondents and respondents with average income or higher. Physicians who practiced in community settings indicated a stronger preference for HaH over hospitalization than physicians who mainly practiced in hospitals.
In an open-ended question in the survey of physicians, several significant barriers to expanding HaH in Israel were mentioned, with particular emphasis on the lack of specialized manpower needed to expand the services, a lack of resources, and insufficient awareness of the service, both among patients and the medical staff.
Conclusions
The findings suggest that HaH services can serve as a possible model for providing high-quality and safe medical service in Israel, a view that is gaining popularity among the public and in even more so among physicians. The findings of the survey can provide insights to policymakers concerning the opportunities and barriers to HaH, to facilitate the expansion of HaH services.
The main recommendations that arise from the findings include increasing the public’s awareness of HaH services; reducing the burden on the patient’s family; tailoring HaH policy according to the various population groups in order to provide services in an equitable and culturally sensitive manner; recruiting hospital staffs to the effort including their involvement in the design and provision of HaH services and finally, investing resources to finance HaH activity and to train the specialized manpower that it requires.