עמוד 1 ^^ MARKETPLACE SHLOMO MAITALMAHAL WHO WILL HEAL THE HOSPITALS The crisisat Hadassah, the country'sleadingmedical center, isonlysymptomaticof the deep malaise affecting Israel'smedical system ALMOST OUT of the blue,.the peopleof The whole mess ended up in the Jeru- Hadassah Medical Center has proud Israel woke up one Januarymorning to salem District Court, where JudgeDavid history,datingback century, when learn that theirpremierresearch and teach- Mintz heard Hadassah's pleasforprotectionHenrietta Szold founded Hadassah the inghospital,Jerusalem'sHadassah Medical from itscreditors,as doctors, the adminis- Women's ZionistOrganizationof America. Center, was drowningin red ink, broke and trativestaff'sunion, and the Health Minis- and sent two nurses to Palestine.The orig- deepin debt. try traded insults.On February ,91Mintz inalHadassah Hospitalon Mt. Scopuswas !tscumulative deficitcame to staggeringgrantedHadassah 90 daysto pay itsbills, evacuated duringthe War of Independence 3.1billionshekels(S370 million),four times includingsalaries,and the employeeswent in ,8491when itsdirectorHaim Yaskywas itssizein .4002Its2013 deficitwas IS 300 back to work. killedin an attack on medical convoy; million 7.58$(million).up from NIS 98 mil- Typically,the problemhas been brewing and new hospitalwas builtin 1960 in Ein lion in ,4002and projectedto rise to NIS for decade, but action isbeingtaken only Kerem, on the west side of Jerusalem. 400 million(SI 3.41million)in .4102 now thatthe illnesshas become life-threat-Hadassah's 000,033members worldwide Doctors, nurses and administrative staff ening.If Hadassah was an individual,it raised some 873$million for the medical went on strike when Hadassah paidonly would file malpracticesuit. center in 2102-8002alone,accordingto US half theirsalariesin Januaryand was short What has made Hadassah so desperate-nationalHadassah President Marcie Natan. NIS 60 million 71$(million)to pay the oth- lyill?Why was the problemnot addressed In ,3102Hadassah's 850 doctors and er half,despite(illegally)dippinginto pen- sooner, before it became near terminal? 049,1nurses in two hospitals,in Ein Kerem sion and income tax deductions And what isthe cure, ifthere isone and the restoredMt. Scopusfacility,served עמוד 2 Nurses, administrative and maintenance workers at Hadassah Medical Center, Ein Kerem, Jerusalem, stage walk-out February ,61 in protestat not receivingtheirfullwages forJanuary over millionpatients,performed 000,53was investedwith Madoff and an estimat- and the healthfunds to Hadassah, currently surgicalprocedures,conducted nearlyhalf ed 031$million(principaland interest)was NIS 594,2 ,)317$(which, accordingto the millionimagingexams and did four mil- withdrawn. But 09$millionremained, and Bank of Israel,"does not include the ful! lionlabtests.Many of the patientswere Is- was lostwhen Madoff's fraudulentscheme priceof hospitalizationservices." raeliand West Bank Arabs factthatwon blew up. In the US, admittedlyfarcostlier,dayof Hadassah Nobel Peace Prize nomination Under Natan, Hadassah decided to return hospitalizationcosts an average of .949,3$ in .5002 54$million,or half of itsMadoff profits,The Finance Ministrythinks underpaying Hadassah women allocated over 60 per- to compensate other losers."We wanted it Hadassah for per-diemfees creates an in- cent of their 6.321$million in totalphilan- behind us,"Natan said. centivefor itto slash costs. In fact,howev- thropicfundingin 2012 to two projects This highlyethicaldecision greatlyre- er, itsimplycreates hugedeficits. the medical center'soperationsand the new duced Hadassah women's abilityto fund When the Health and Finance Ministries 19-storyDavidson Tower, estimated to cost the medical center. Itisbitterlypainfulthat conspireto pay hospitals,includingHadas- staggering 063$million. Jewish crook has done such immense sah, lessthan theircosts per bed per day, One cause ofthe current crisisisthe Ponzi damage to flagshipprojectof American drivingthem to slash costs elsewhere, and scheme of Bernard Madoff, now serving Jewish philanthropy. when theymandate deepdiscounts forhos- 150-yearsentence in US federal prison. Another cause "10the crisisis the inad- pitalizationdaysby privatehospitalslike Hadassah women have over the years ac- equatesystem for reimbursement per day Hadassah to health insurance funds, they quirednearly 005$million in assets. Some of hospitalization,paidby the government are stealthilyforcingHadassah women to עמוד 3 subsidizeIsrael'streasury,bypayingforthe WILL HADASSAH resultingoperatinglosses.This isunethical and deplorable. SURVIVE AS GREAT The Hadassah crisis has laid bare Israel'sstingyinvestment in health care. TEACHING AND Israelspends 941,2$per capitaannuallyon RESEARCH HOSPITAL? health care, one-fourth that of the US, or lessthan percentof Gross Domestic Prod- OR WILL ITBE TURNED uct 71(percentin the US).Yet Israelislive three years longerthan Americans, on aver- INTO AN ORDINARY age. Only60 percentof health care spend- ingin Israelisfunded by the publiccoffers, HOSPITAL not much above thatof the US 35(percent), which has no nationalhealthinsurance.The rest comes out of our pockets.There is To fullyunderstand Hadassah's deficits, growingshortageof hospitalbeds and doc- we need to understand pervasiveillness tors;800 new doctorsare needed each year, known as Baumol's cost disease, named but only525 graduateyearlyfrom medical after my Princeton mentor and teacher, schools.And the number of nurses in Israel Prof. William (Jack)Baumol. Nearly50 per 000,001persons isamong the lowest in years ago, Baumol explainedthatthere are the West two basic sectors in any economy: Labor intensive services like health care whose Sarah Davidson Tower, which has drawn THE MAIN cause of Hadassah's deficitsis productivitydoes not rise,and hi-techprod- fire because it is expensive,partlyempty itshighoperatingcosts. ucts likecomputers,with risingwages and and stillneeds another 54$million to be To get doctor'sview of the crisis,spoke risingproductivity.Health care costs soar, completed.It was made possibleby 57$ with Dr. Charles Milgrom, distinguishedtrappedin the vice of risingwages (tocom- million giftfrom the late William David- American-born orthopedicsurgeon who re- petewith hi-tech)and constant productivityson, founder of Guardian Industries, ma- tiredlastyear from Hadassah after32 years syndromenow named afterBaumol. jorUS glassproducer. of service. Accordingto Milgrom,"Every America is an extreme case. In his 2012 "The Davidson Tower buildingwas very countryor state needs true universityhos- book, "The Cost Disease: Why Comput- expensive;itwas builtfor the needs of the pital,to producethe next generationof doc- ers Get Cheaperand Health Care Doesn't," next 40 years, not for today'sneeds," Mil- tors of excellence...Such hospitalsare not Baumol notes that"if[US]healthcare costs grom explains."To do otherwise would be economicallyviable.You can't do research continue to rise [asin the past].theywill unwise. It had to be built with an under- unless you have time to do it;and during risefrom 15 percentof the average person'sground facility,because of Israel'ssecu- thattime, the research doctor isnot generat- totalincome in 2005 to 62 percentby ".5012rityneeds. This is very expensive.Israeli ingincome by the traditionalmethods." Baumol contends that politiciansdo not citizensgot bargain,because itcost them He notes that he himself had day and understand Baumol's Disease clearlythe nothing." half week for research, which led to case in Israelas well. The choice is to re- The factisIsraelitaxpayershave over the 109 publishedpapers on orthopedicson duce the quantityand qualityof healthcare, years received an immense windfall from stress fracturesand on patient-specificor to pay for itout of the productivitydiv- Hadassah women. Every singlebuilding, bone-specificmathematical approachfor idends of "computers"and their ilk.The every bed, every device at Hadassah was calculatingbone strength. Hadassah crisisshows Israelis at crucial paidforby them. The unwritten socialcon- "Hadassah isspecial,"MilgromtellsThe decision point.We can onlyhope itdoes tract with Israelsaid,we (Hadassahworn- Jerusalem Report."On the other side of not opt to degradeour health.Israel'spro- en)build it,you pay to run it,and we'llhelp. revolvingdoor is the Hadassah Medical gressivehealth insurance tax, of up to 8.4 The same deal appliesto, for example, School. This is quiterare, to have great percentof income, isnot adequateto cover the Technion-Israel Instituteof Technolo- teachinghospitalrightnext to medical risingcosts. gy, where allthe buildingsand most of the school." asked Milgrom about the 063$million lab equipmenton itscampus were donated עמוד 4 patientswith respect,providedthem with informationand explainedeach procedure, despitethe pressure of hoards of illpeople. As one doctor toldme, Hadassah isindeed an American hospitalin terms of itspa- tients-are-our-clientsculture. Hadassah Medical Center Director- General AvigdorKaplanunderstands this well.In recent memo to staffand doctors, he observed, "I believe our patientsmust leave Hadassah with the feelingthat they have been embraced with warm hug.We have to invest extra effortto enhance pa- tientsatisfaction.It is an essentialpartof Hadassah's human touch." This israre in Israel,where goodservice isscarce. Hadassah has come under fire for its privatemedical services, which co-exist in the same facilitywith national health insurance services."Private medical ser- by supportersabroad. know of no other But itisclearthatwhen