The next time you find yourself waiting for three hours at your local accident and emergency department with a badly sprained ankle, you might wish to compare the experience with that of your Israeli counterpart.
Jerusalemites, for example, tend not to have to wait ages to have their injuries tended to, particularly if they attend the state-of-the-art facility in the city’s Shaare Zedek hospital. Its director-general, Dr Yonatan Halevy, is proud of the treatment he can offer, but he is also very grateful — because the situation would be markedly different without the help of British Jews.
“Our emergency department is the largest in Jerusalem and one of the largest in the country,” he says. “It was built from scratch for $20 million [just over £13 million] of which $12 million [almost £8 million]came from British Jews. During my 20 years at Shaare Zedek, British Jews have given disproportionately, certainly compared to the Americans.”
So given that our own health service is struggling and money is, let’s face it, a little tight at the moment, why should the British community be funding healthcare in Jerusalem? The answer lies in the anachronistic position of hospitals in the Israeli capital. Because of the centrality of the city of Jerusalem to the three monotheistic faiths — Judaism, Christianity and Islam — voluntary organisations invested in the city long before the declaration of the state of Israel. A group of German and Dutch Jews decided in 1873 that a modern hospital outside the walls of the Old City was needed. It took them 29 years to raise the money to build the hospital in Shaare Zedek. So, long before the establishment of the state, healthcare in Jerusalem was funded on a voluntary basis. “The Israeli government decided that it was convenient to leave things as they were,” says Halevy with a wry smile.
Shaare Zedek hospital sells services to the four healthcare providers — known as the “‘sick funds” — contracted by the government to provide medical services to Israelis. This provides 95 per cent of the hospital’s running costs. But to establish new departments or buy modern machinery, Shaare Zedek — like Jerusalem’s other famous hospital, the Hadassah — is wholly dependent on voluntary contributions. So what do donors get for their money? “Representatives of every cultural and ethnic group that resides in our multicultural and multi-ethnic city serve on the staff of the hospital and are eligible for treatment,” says Halevy. “This is an important concept. Maybe there are some Jews in this city who do not care about non-discrimination, but we insist on that. The hospital is run according to Jewish law and serves as living proof that modern medicine can live hand in hand with our ancient Jewish law, serving everyone in the city. I think that donating money to this kind of cause is a very tempting proposition.”
Some may feel that being the director of such an institution may not be such a tempting proposition. After all, not only does he have the responsibility of running a modern, complex institution, he also knows that if he wants a new MRI scanner, he has to persuade a supporter of Shaare Zedek to part with the money to pay for it.
But Halevy is happy to take on this responsibility. In fact, he says that fundraising accounts only for 10 to 15 per cent of his time. He spends far longer — around 25 per cent of the 12 hours he spends at the hospital every working day — treating patients. Is this a good use of his time when his primary responsibility is running the hospital? He is adamant that it is.
“I see clinical work as a superb managerial tool. It’s one thing to sit in an ivory tower making decisions about rationing, but it’s a different story when you have to face the patients and their families. You can make much more balanced managerial decisions when you are in the field and personally involved.”
The mention of healthcare rationing sparks a comparison between healthcare in this country and in Israel. Halevy feels that the systems are comparable, but that the Israeli model has the edge. In both systems, a wide range of heathcare services are free at the point of delivery, costing each government a similar percentage of its GDP — 8.1 per cent in the case of the UK, and 7.9 per cent in Israel.
“I would differentiate between the level of medical care and logistics,” says Halevy. “I read the British Medical Journal and The Lancet every week and Britain should be very proud of the level of medical research, innovations in medicine and its great pharmaceutical companies. But in terms of logistics, we are doing better. In Israel there is no long waiting list for cardiac surgery. The UK is doing much better than previously on waiting lists for routine surgery — down from two years to about seven months — but in Israel you will wait for only two weeks.”
Although there are similarities in the two models, there are different priorities. In Britain, alcohol -related conditions present a huge challenge to healthcare providers, but in Israel this is not the case, as Halevy, a specialist in liver disease, can testify. However, the two countries share the challenge of coping with diseases resulting from obesity and poor lifestyle choices like smoking. In addition, Israeli emergency departments need to be equipped to deal with mass casualties from terrorist actions and war — one of the imperatives which spurred fundraising for the new emergency department at Shaare Zedek.
Israel is also coping with a rapid drop in its ratio of physicians to patients — the highest in the world 15 years ago thanks to the influx of doctors from the former Soviet Union, who are now reaching retirement age. Halevy hopes the government will approve the foundation of a fifth medical school to provide the doctors to cope with an increased number of patients. “In difficult financial times like these, more people need treatment. There is an inverse correlation between poverty and health,” he says.
Having said that, he still feels happy to be a physician in Israel. “We do not have a brain drain like you have in the UK. I always used to say that it was better to be a patient in Israel and a doctor in America. I’m not so sure this is true for doctors anymore.”
Snapshot
Shaare Zedek (a term from the Bible meaning “Gates of Righteousness”) has come a long way since it was founded in 1902 as a 20-bed hospital. It now occupies an 11-acre site in central Jerusalem and employs a medical staff of almost 400 doctors and 800 nurses, caring for nearly 250,000 patients a year in its 30 departments. Its emergency department, which is responsible for treating the victims of war and terrorist incidents, has been located under ground to protect it in the event of an attack against the city.
