Although the management of Shaare Zedek Medical Center might be expected to celebrate the deep financial trouble of its longtime rivals, Hadassah-University Medical Center in Ein Kerem and Hadassah Hospital on Mt. Scopus, that is the furthest thought from their minds.
“We look at Hadassah’s suffering with great pain. Jerusalem, with its 800,000 residents, can’t manage to get the tertiary healthcare it needs from us alone,” said SZMC director Prof. Jonathan Halevy, an internal medicine, liver disease, and health administration specialist who has been in his post for 26 years. SZMC (including Bikur Cholim Hospital, which it runs) covers 40 percent of the capital and the two Hadassah hospitals the remaining 60%.
“There has to be a Hadassah Medical Organization (HMO),” Halevy told The Jerusalem Post on Sunday, “and I sincerely hope that it will recover and thrive. I believe it cannot and will not fall. The government knows this.”
Halevy is a close personal friend of Prof. Shlomo Mor-Yosef, who for 11 years was HMO’s director (until 2011) and is now director-general of the National Insurance Institute. They have met every Friday for lunch as part of a circle of influential veteran Jerusalemites.
Mor-Yosef came to the surprise celebration of Halevy’s 25th anniversary as director last year and delivered very warm words in his honor.
Halevy mourns HMO’s deterioration and has refused to accept dozens of Hadassah physicians who have pleaded with him to hire them. He does not want SZMC to be a bird of prey feeding on the choicest parts as Hadassah writhes in pain.
In 10 or 15 years, Halevy said, “the people of Jerusalem will kiss the hands of Shlomo Mor-Yosef and the American Hadassah women for the $360 million hospitalization tower that they raised funds for and built to replace the 50-year-old hospitalization facilities.”
One of his predecessors, the late Prof. David Maier, was bitterly criticized for moving SZMC from its old Jaffa Road location to the huge new premises opposite Mount Herzl in 1979. SZMC suffered significant and depressing financial problems as a result of the construction.
But years later, when Halevy was already at the helm, SZMC board members lauded Maier for his prescience.
Now the hospital is expanding and flourishing without having onerous debts. An advanced New Generation building for women and children is to be fully open by the end of this year.
Despite the current Hadassah crisis, Halevy is optimistic that in another two or three months, HMO will be pushed onto the correct path. A painful recovery program and significant government grants and loans, as well as boosted donations from HMO’s owner, the Hadassah Women’s Zionist Organization of America, will ensure that the organization again looks toward the future. He believes an infusion of some NIS 600 million to cover short-term debts will be enough to turn HMO around.
Yet, for this convalescence and recuperation to occur, there are significant changes that must be adopted to turn HMO around, Halevy suggested.
Over the decades, he recalls, Hadassah used to think it was the only game in town. This led to some arrogance and bloated manpower and exaggerated salaries among the more senior physicians, putting a heavy weight on HMO’s budget.
When some medical “stars” threatened to leave for various reasons, management for years let them go, saying that HMO would manage without them, but many patients went elsewhere with them, he said.
“At Shaare Zedek, we internalized as a hospital culture among the staff that, as a public hospital with private owners, we live only from the fruits of our efforts. Without income, we can’t pay salaries,” Halevy said.
Some of the best senior physicians and researchers got their start at Hadassah and now work in leading departments and positions in hospitals around the country. HMO is no longer the only game in town; there was no place for arrogance.
SZMC delivers many more babies than the two Hadassah hospitals combined, has more emergency room visits, and surpasses it on other measures of activity, he continued.
HMO now has an annual NIS 1.7 billion turnover, with 5,000 full-time positions and 6,000 employees, while SZMC has an equivalent turnover of NIS 1.2 billion with only 2,400 full time positions and 3,300 employees. It is true that HMO has a medical school to run and has performed half of all medical research conducted by hospitals, but these are relatively small costs compared to the hospitals’ functioning, Halevy said.
As a rule, the American women of Hadassah haven’t understood the medical system as Israelis do. Despite not living here and not knowing how to negotiate with Israeli unions or even speaking fluent Hebrew, they have dictated to HMO management on a wide variety of issues.
SZMC, which has the same public/private status, has a non-profit international board consisting mostly of Israelis well familiar with the country and the system. Halevy, who regularly goes around the world as part of his job to raise funds for the hospital rather than being dependent on a single women’s organization, reports directly to his board. If he had not succeeded, he would have been dismissed.
HMO has had a legal private medical services (Sharap) arrangement for 50 years, and SZMC a similar one for 40 years, but at SZMC it is limited to nine percent of surgical procedures with senior surgeons and eight percent of clinic consultations. He does not know the equivalent at HMO, but he noted that despite Jerusalemites’ reputations for “loving Sharap,” most residents of the city can manage without choosing their doctor.
Aside from the proper governance and employee culture, HMO needs managerial stability – it has had four directors in less than 15 years, Halevy noted. Prof. Ehud Kokia, who previously ran the Maccabi health fund, lasted little more than a year before resigning over the financial problems.
HMO, which has apartments and other property in the city, should sell them off to help pay its debts, Halevy suggested.
Although the Israel Medical Association declared that doctors at all public hospitals in the country would hold workers’ assemblies for two hours on Sunday, SZMC did not (with permission from the IMA), because “with HMO functioning only partially, somebody has to work full time to treat patients. We had 15% more emergency room visits than usual during the Hadassah sanctions, Halevy noted.