Hadassah’s State-of-the-Art Care Challenges the Balance Sheet

Giving up benefits and taking up more hard work, Hadassah’s staff has shown seriousness of purpose but might be growing over-strained.

Hadassah patient roomBy Ari Keren-Yaar

Can a hospital go down like a great whale hunted out in the open sea, without a force to lift it from the abyss? That is the Moby Dick question facing Hadassah Medical Center in Jerusalem. It sounds dystopian that any hospital should fail on economic grounds, let alone the campuses and hospitals of Hadassah, backed by a rich organization, serving a small country with an upbeat economy.

A recent history of Hadassah – a double-hospital health system in Jerusalem, including the country’s first medical school – saw the construction of a mighty hospital tower, along with the accumulation of mighty debts. The tower and the debt struck the people of Jerusalem as creatures of the same mold: take a huge pile of money, carve a tower out of it, leaving a huge debt behind. But the tower, named after Sarah Wetsman Davidson, is a philanthropic gift on par with the most generous donations known even for US hospitals. The operating debt is bigger by a factor of five.

Providing state-of-the-art care for the poor, expanding populations in and around Jerusalem has never been easy on the balance sheets. Depreciated dollars were blamed for diminishing returns from donations. Management was blamed for reducing service charges in order to draw in more activity, facing an increasingly competitive national health market. The press vilified doctors who were enriching themselves (with annual incomes of a million dollars) off the reputed private medical service in a manner that encroached on their regular hours and regular duties.

Henrietta Szold and her Zionist Women’s Organization of America laid the foundations of Hadassah in the Holy Land back in 1913. The organization funded the hospitals ever since until it had to relinquish some control in return for treasury funds, over a year ago. As the hospital has not shaken off its dismal debts and is seeking a general manager, a partnership with the heavy-handed Finance Ministry boded ill. For one, the executive branch, employing Bolshevik-style scrutiny (possibly embedded in certain genes of Israeli governments since Ben-Gurion) might just suck the life out of bold candidates eager to lead the venerable, ailing institution.

In such an age even a stubborn pulpit would balk at sounding off the message: Hadassah deserves all the good it can get. Its practitioners, some disillusioned by salaries decimated, may wish to move away; postmodern skeptics with their disheveled good and bad may not appreciate the value of such a consistent health provider. They would rather opt for anti-vaccine campaigns. Finally, armageddon-mongers seeking power everywhere in the Middle East would disapprove of what Richard Horton, editor of The Lancet, and others acknowledged back in 2005 about Hadassah – its nomination for the Nobel Peace Prize for exceptional openness and medical care.

It seems a viable option these days to eradicate the culture of Hadassah (where everyone practically meets and treats everyone and not only their kind), dispersing its approachable academics, stubborn researchers and unyielding, world-class clinicians. So is flinging the entire citizenry, denominations, sects and all on the open arms of religious foundations and their myriad smaller hospitals in Jerusalem. These are the only alternative, barring migration to Tel Aviv.

But perhaps anyone who has been to Jerusalem would do well to realize that for all the clashes, tensions and segregation this fascinating city both offers and avoids, we all share Jerusalem. And Hadassah as its guardian.

Ari Keren-Yaar works in medical education and health information technology projects and has previously served as a physician at Hadassah.