Researchers: Roni Peleg¹, Yochai Schonmann², Yuval Landau³, Yahav Shvartzman⁴, Yotam David Ginati⁴, Hagit Levine³

Background: Children with life-threatening chronic conditions often experience complex morbidity, recurrent hospitalizations, and significant physical and psychosocial symptoms, particularly at the end of life. Despite the recognized importance of pediatric palliative care, there is limited information in Israel regarding the size of the population requiring such care and their patterns of healthcare utilization.

Objectives: To estimate the size of the pediatric population requiring palliative care in Israel and to characterize their healthcare utilization, both overall and during the last year of life.

Method: A population-based study was conducted using the databases of Clalit Health Services. Children who died between 1999 and 2025 were first identified, and based on their diagnoses, a list of life-threatening chronic conditions was compiled. A cohort of children aged 0–18 with these diagnoses between 2000 and 2025 was then constructed. Healthcare utilization was analyzed from diagnosis until the end of follow-up, and during the last year of life among those who died.

Findings: The cohort included 83,419 children, of whom 3.9% died during the study period. In the last year of life, healthcare utilization was high, including recurrent hospitalizations, emergency department visits, and intensive care admissions. In contrast, more than 95% of the children did not receive a palliative care consultation.

Conclusions: Children with life-threatening conditions in Israel utilize substantial healthcare services, particularly near the end of life, yet receive very limited dedicated palliative care services.

Recommendations: A structured national pediatric palliative care framework should be developed, with expanded availability of services in both community and hospital settings.

Research end date: 03/2026