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Couple mortgage home to fund knee surgery

Reporter: Heather Ewart

KERRY O'BRIEN: After a brief flurry of activity, the suggestion by NSW Premier Bob Carr that the
Federal Government take total control of the health system seems to have been consigned to history.

In its wake, Australia's health system continues to grapple with the bureaucratic nightmare created
by the mix of federal and State funding.

In the bush, where specialist services are much harder to access, it can lead to particular
hardship, like the woman who opted to mortgage her house to go to the city for surgery.

Heather Ewart reports.

HEATHER EWART: Joyce and Jack Soar live on the edge of Victoria's high country in East Gippsland.

They're pensioners with no private health insurance and they've just mortgaged their house to pay
for Joyce's knee reconstruction surgery in the city, four hours' drive away.

It was one of the most distressing decisions of their lives.

JOYCE SOAR: When you've, all your life, struggled to bring your kids up, give them a good
education, you have bought your house, you've got no debts other than rates and things like that.

I didn't want to have a mortgage, but they wore me down in the end so that was it.

HEATHER EWART: Joyce Soar became the innocent victim of hospital cutbacks at the nearby regional
centre of Bairnsdale earlier this year.

She had been on the waiting list for months to have her knee surgery done locally by a visiting
Melbourne specialist and was amazed to learn this was not going to happen.

JOYCE SOAR: I didn't believe it at first.

The hospital had cancelled all hip and knee operations and put it in the paper and a friend rang up
to tell me, "Have you read it?"

When I contacted the hospital, they told me to contact my specialist, which I had, and he said he
wouldn't be coming back to Bairnsdale.

HEATHER EWART: Faced with the prospect of going on another waiting list or switching specialists,
Joyce Soar decided she couldn't deal with the pain or confusion anymore and opted to have the
surgery done in the private system in Melbourne at a cost of $16,000.

DR MARK STEVENS, VISITING MEDICAL OFFICER: A number of my patients haven't really realised until
suddenly they have been left in the lurch, expecting to be operated on and then suddenly getting a
letter saying, "I'm sorry, but your specialist cannot offer services at our hospital anymore."

HEATHER EWART: Dr Mark Stevens is Joyce Soar's GP.

Like many of his colleagues, he was incensed to learn that elective surgery at the local hospital
would be cut substantially and visiting specialist services curtailed or dropped because of a
budget shortfall.

Some patients would now have to resort to the long trip to the city for treatment.

DR MARK STEVENS: To me it's doubly mean because this is one of the poorest areas in Victoria.

HEATHER EWART: Bairnsdale has a population of 13,000, but it serves a region of 40,000 that
stretches to remote areas on the NSW border and covers a growing number of retirees.

This town now finds itself at the centre of a complicated federal/State health funding wrangle and
service cutbacks that would not be alien to other rural communities in Australia.

It also highlights a growing frustration in the bush that city dwellers seem to be getting a better

MAN: We miss out a lot in the country and it seems that we get that feeling we don't matter here,
that sort of thing.

WOMAN: They should be improving it up here.

More and more old people are coming up here, like we did.

MAN 2: They're trying to get more people into the region.

This sort of thing will take then away from it.

HEATHER EWART: The community's anger was fuelled by local media reports, which broke the news of
the hospital board's cutback plans and actively campaigned against them.

What emerged was a problem stemming back over a number of years, when the hospital was billing the
Federal Government for hundreds of day surgery cases instead of the State Government.

This is one way of hedging funds to treat more patients.

DR JOHN URIE, CHAIRMAN OF VISITING MEDICAL OFFICERS: As far as the medical community and our
patients were concerned, we were unaware that it was a problem at all.

It happens in a lot of hospitals to varying degrees.

But it just continues to be a problem with this State/federal divide in health.

GARY GRAY, CHIEF EXECUTIVE, BAIRNSDALE HOSPITAL: There appears to be some situations in which
patients weren't formally admitted here historically, which means that the Commonwealth would pay
for the doctors' fees, but those practices don't exist anymore.

HEATHER EWART: In 2002, the board and the hospital's CEO moved to rectify the old way of doing
things and what then showed up on the State's books was a major increase in surgery.

BRONWYN PIKE, VICTORIAN HEALTH MINISTER: A couple of years ago, there was a rapid increase in the
amount of certain surgical procedures, raced right ahead of the resources that were available to
that hospital, and it's important that those resources are used wisely and that the hospital works
within its budget.

DR MARK STEVENS: Through a quirk of funding, an argument or cost-shifting exercise between the
Federal and State Government, are people in East Gippsland - and I'm sure rural people all over
Australia - are suffering.

HEATHER EWART: Over the years, Bairnsdale has steadily attracted specialists from Melbourne to
visit the hospital regularly for consultations and surgery.

They, too, would become part of the cutbacks - among them, Monash IVF specialist Dr Mac Talbot who
dealt with infertility problems and recently set up an IVF clinic at Bairnsdale.

MAC TALBOT, IVF SPECIALIST: At the end of the July, the hospital administration notified me that
due to their budgetary restraints, that all my services were to be stopped at the hospital.

HEATHER EWART: He wasn't the only one to receive a "Dear John" letter.

Others included a Melbourne eye specialist who'd served the community for 26 years and was advised
his schedules would be curtailed due to a budget problem.

So, he quit.

There have been four resignations so far.

MAC TALBOT: With this sort of insecurity, it is very hard to make any long-term plans in an area
like this.

GARY GRAY: Well, the decision of the specialist to leave is entirely theirs.

What we've done is reduced, in some instances, their capacity to access our theatres.

HEATHER EWART: The irony here is that the Federal Government has started subsidising city
specialists to visit rural communities in need.

DR MARK STEVENS: That's why we're, you know, confused.

We get them up here and then we can't pay for them.

BROWNYN PIKE: If the hospital made a decision at some time in the past to put on more visiting
medical officers than it actually had the budget for, then it's appropriate that the hospital now
brings that back into line.

HEATHER EWART: But as Bairnsdale community outrage has grown, the bureaucrats in the Department of
Human Services summoned the hospital board to Melbourne for explanations.

DR MARK STEVENS: The members of the board were told that if they didn't go to the press, the
Bairnsdale Hospital budget would be increased, and they were also told that if they did go to the
press, that the Bairnsdale Hospital budget would suffer.

BROWNWYN PIKE: I don't believe this allegation is accurate and I think it is actually quite
unhelpful because we've been working very closely with the voluntary board of management.

HEATHER EWART: The hospital board here was unavailable for comment.

Perhaps they're all too mindful of the fate of their colleagues at a neighbouring hospital 60km
away, where an entire board has just been sacked by the Victorian Government for alleged funding

HEATHER EWART: How does that make you feel, a bit nervous or not?

GARY GRAY: Um - oh, well, I suppose it puts you on an edge, but there is an edge in every job.

HEATHER EWART: The hospital funding issue is complex and confusing.

So is the formula for who gets what in each State.

The Victorian Government argues it boosts funding to hospitals each year and accuses the Federal
Government of not meeting its side of the bargain, accusations the Commonwealth denies.

The medical profession is fed up.

MAC TALBOT: I promise you you'd need more than a university education to totally understand it.

DR JOHN URIE: It's a mess.

I mean, everyone involved in health care realises that this system is unworkable in the long-term.

DR MARK STEVENS: Country people just want the services that are due to them, the services that any
Australian would expect.

HEATHER EWART: And ultimately, it's patients like Joyce Soar around the country who pay the
heaviest price for a debate that goes round and round in circles with no resolution in sight.

KERRY O'BRIEN: What was that interesting line from the hospital?

It's up to the surgeons whether they come or not, we're just reducing their access to the theatre.

That report from Heather Ewart.