Augusta Victoria Pediatrics

I spent another day in Jerusalem’s Augusta Victoria Hospital today. I followed the Pediatric Hematology/Oncology/Nephrology team again. Dr. Khadra (“Green”) talked with me about how few specialists practice in the West Bank. She told me about a friend in residency who trained at Makassed Hospital in Jerusalem before leaving to do fellowship training in Jordan to become a Peds Hem/Onc  specialist. When he applied to return to Jerusalem to work, the Israeli authorities denied his application, citing security concerns. No appeal or legal options are available to him. And the Palestinians have one less specialist available to them.

This is not an uncommon story, from what Dr. Khadra says. She is trying to follow a similar training course herself. Palestinian doctors trained at the Il Kutz (Arabic for “Jerusalem”) University cannot do residency or fellowship at Israeli programs. Why? Because the Il Kutz University is the Arabic University in Jerusalem, and Israel does not recognize it, favoring the Hebrew Jerusalem University. Politics in the way of healthcare, yet again.

We talked about how Palestinians pay for services at the referral hospitals as well. A 1500 shekel/year fee buys any non-refugee Palestinian healthcare coverage under the Ministry of Health, and this includes subspecialty referrals. However, it does not cover an initial self-referral. The only way the fee is kept this low is with the heavy use of international financial aid support for the healthcare system in the West Bank. And still, they have difficulty attracting qualified specialists, because they are unable to competitively reimburse them.

The insurance purchased from the Ministry of Health covers healthcare costs with a 10% deductible. The patient’s family only pays 10% of the bill (and the prices are lower than in the US). On the other hand, the UNRWA coverage for refugees has a 30% deductible, and some tests/treatments are never covered. This is a problem, because the non-covered things have no medical rationale behind them. There is just a list of “acceptable” tests and treatments, and if a refugee patient requires something that isn’t on the list, they have to pay for it out of pocket, end of story.

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