The $6 co-payment sickly Australians face for visiting a bulk-billing doctor — now rubber-stamped by the government, The Australian reports today — will generate the most heat and light come budget time. But a decision to de-fund Labor’s primary healthcare initiative in Medicare Locals — which now seems certain, the ABC reports — will have the biggest impact.

If there’s consensus among healthcare professions here and case studies overseas it is this: the need for greater primary healthcare, easing the strain on hospitals, which shouldn’t be the first port of call for patients with developing conditions. Medicare Locals was an attempt, however imperfect, to enact vital reform.

Not all of them are efficient. But the initiative needs time to work. Crikey‘s health blog Croakey has canvassed the views of professionals working in these facilities over the last few months. Comments from Jason Trethowan, co-ordinator of the Barwon Medicare Local, are typical:

“I don’t doubt that there could be improvements, and some Medicare Locals might be performing better than others, but international evidence shows that the sustainability of any health system is improved by strengthening primary health — treating health problems before they become acute and need more expensive hospital care. Saving hospital resources for those who need them is essential for the future of a safe and quality health care system.

“Medicare Locals exist to strengthen primary healthcare. Through local partnerships, Medicare Locals are enabling challenging conversations to occur. The kind of conversations not had before, and they are following through with positive action.”

But is the government open to a second opinion?