A taste of the way Medicare Locals are likely to transform health care policies has come in a forthright debate on day one of the national primary health care conference, according to Mark Metherell. Follow the conference via Twitter #nphcc.

Now that Medicare Locals are in full swing and solidly supported by the Health Minister, Tanya Plibersek, the thorny issue of allocation of resources between primary health care and hospitals has surfaced. The argument gives a hint of the way the grassroots role of MLs can bring health policy making down to earth. Ms Plibersek said that the Government would not load more responsibilities on to MLs without more funding. Her support for “the shifting centre of gravity” towards primary health services, was a prelude to a lively exchange after she left the Adelaide convention.

Should the $20 billion plus that goes to Medicare and PBS be restructured to stimulate healthier, more effective outcomes through primary care? Should Medicare Locals be arguing for a greater share of funding to reflect their cost effectiveness in keeping people out of hospital? Forthright GP Sue Page says the evidence supports the economic and therapeutic benefits of primary health care in reducing demand for hospitals and it was now time for action to give greater priority to resources for GPs over specialists. Dr Page told the plenary session at the Australian Medicare Local Alliance, of which she is a director, it was time to get past “airy fairy words” and start dealing with the tough questions posed by growing primary care sector. “If you can’t answer those questions we are wasting our time.”

Fellow North Coast Medicare Local CEO, Vahid Saberi, who previously as a NSW Health executive presided over 22 public hospitals, said he knew he could have improved local health outcomes if he had been able to close 20 hospital beds and deploy the savings into primary health services. But the current funding system prevents such solutions. Another questioner suggested it was time for there to be an open debate on restructuring Medicare benefits and the PBS to generate more funding for more efficient primary care.

When that was put to Health Department deputy secretary , David Butt, at the end of the session, he joked: “It’s time for lunch.” Mr Butt said there was no suggestion the Government would consider “cashing out” Medicare benefits. But he indicated there might be other financial solutions.

• Declaration: Mark Metherell has been commissioned by the Australian Medicare Local Alliance to write an account of the current activities of Medicare Locals.

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