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Going to hospital: Choosing a hospital

Choose the right hospital to receive the best-quality treatment you can afford.

If you’ve been told by your doctor or specialist that you need to go to hospital for a procedure, one of the key decisions facing you is the choice of hospital.

There are several important factors you need to consider when deciding on a hospital, so let’s take a closer look at how you can choose the right hospital and receive the best possible care.

Private vs public

One of the most important decisions you need to make, is whether to go to a public or private hospital.

If you have a Medicare card and private hospital cover with an Australian health fund, you have the freedom to choose whether you would like to be treated in a public or private hospital. However, if you don’t have private health cover you will need to undergo treatment in a public hospital.

If you choose to be admitted as a public patient, you’ll be treated by specialists nominated by the hospital and Medicare will cover your hospital accommodation and specialist fees.

On the other hand, if you’re a private patient you can choose your own doctor and potentially access a private room, while your theatre fees, hospital accommodation and more are covered by your health fund.

However, it’s worth pointing out that if the specialist you want to provide your treatment only works at specific hospitals, this may influence your decision. In some cases you may want to receive treatment at a specific hospital simply because it has the best facilities for someone with your medical condition.

Private vs public: A closer look at what’s covered

Should you choose to be treated as a private patient in a private hospital, or as a private or public patient in a public hospital? The table below outlines how your choice will affect the treatment you receive.

Private patient in a private hospitalPrivate patient in a public hospitalPublic patient in a public hospital
Can I choose my specialist?Yes, provided you are not admitted as an emergency patient.Yes, provided you are not admitted as an emergency patient.No. You will be treated by a specialist or specialists appointed by the hospital.
Can I choose my hospital?Yes, depending on the specialists you choose and where they work.Yes, depending on the specialists you choose and where they work.In some cases. Choice is dependent on where your specialist works and when a place becomes available on the public hospital waiting list.
Can I choose when I will be treated?Yes, you will be treated as soon as you and your specialist are ready.Yes, you will be treated as soon as you and your specialist are ready.No. The time you will have to wait for treatment depends on how long it takes for a place to become available on the public hospital waiting list.
Can I access a private room?Yes, if available and covered by your health fund.Yes, if available and covered by your health fund, and depending on your clinical needs.Maybe, but this depends on the hospital where you undergo treatment – private rooms are allocated to patients who need them the most.
Will I need to pay hospital accommodation costs?No, you will typically not have to pay any accommodation costs if you visit a hospital with which your health fund has an agreement. However, an excess may apply to your policy.While some or all of your costs will be covered by your health fund, you may need to pay extra to secure a private room. A hospital excess may also apply to your policy.No, these are covered by Medicare.
Will I need to pay specialist fees?Maybe. While Medicare and your health fund cover these costs, you may incur out-of-pocket expenses if your specialist charges more than the MBS fee. However, this gap may be covered if your specialist participates in your health fund’s gap cover scheme.Maybe. While Medicare and your health fund cover these costs, you may incur out-of-pocket expenses if your specialist charges more than the MBS fee. However, this gap may be covered if your specialist participates in your health fund’s gap cover scheme.No, these are covered by Medicare.

Gaps and out-of-pocket expenses

Another important point to consider when choosing a hospital is whether or not you will need to pay any out-of-pocket expenses. These expenses arise if your specialist charges more than the Medicare Benefits Schedule (MBS) fee for your procedure.

The difference between the MBS fee and your specialist’s fee is known as the gap, and paying this amount could cost you a significant amount of money.

However, to help reduce or eliminate this out-of-pocket cost, your health fund may run what is known as a gap cover scheme. If doctors participate in your fund’s gap cover scheme, they agree to charge a set fee for their services, which means you won’t be left with any bills to pay yourself.

With this in mind, it’s important to be aware of how much your specialists charge for a procedure, as well as whether or not they participate in your health fund’s gap cover scheme, before starting treatment.

Contract and agreement hospitals

Australia’s health funds have contracts in place with private hospitals located all around Australia.

Under these agreements, insurers have special arrangements in place to help limit the out-of-pocket expenses their members have to pay when they undergo treatment.

By choosing a hospital that your fund has a contract, you could potentially save yourself thousands of dollars by reducing your additional expenses, or even eliminating them altogether.

Contact your health fund for a full list of its local, contract/agreement hospitals, but remember that this is far from the only factor you should consider when choosing a hospital.

Questions to ask the hospital

Before deciding on the right hospital for your treatment needs, make sure to ask the following:

  • Will I have any out-of-pocket costs during my time in hospital?
  • How much will those costs be?
  • When will I need to pay the excess or co-payment that applies to my hospital cover health insurance, if applicable?
  • What payment methods are available?
  • Will I receive a private room for the duration of my stay?
  • Can I choose my own doctor?
  • Are there any appointments I need to attend before my admission?
  • Can you give me any information on what I need to do to prepare for my hospital visit, or what I need to bring with me when I’m admitted?

You may also have specific questions regarding your care. For example, if you’re going to hospital to have a baby:

  • Does the hospital have birth pools and other facilities that match your birth plan?
  • What is the hospital’s intervention rate and Caesarian section rate?
  • Will you have the same carers during labour?
  • How long do new mothers usually stay in hospital after giving birth?

The answers to these questions will help you make an informed choice about where best to deliver your baby.

Your rights and responsibilities

When choosing a hospital you have a right to:

  • Receive a detailed outline of any out-of-pocket expenses you may have to pay prior to your admission.
  • Expect that if your medical condition changes during treatment and it’s not possible for the resulting effect on potential costs to be discussed with you, the hospital will inform you of these costs as soon as possible after the procedure.
  • Confidentiality and privacy.
  • Be treated with dignity and respect.

However, you also have a few important responsibilities. You must:

  • Understand what is involved in your treatment, including the potential benefits and risks.
  • Understand the costs involved in treatment and what is and isn’t covered by your private health fund.
  • Follow any pre- and post-surgery instructions from your specialist.
  • Complete and return any hospital admission forms as soon as possible.
  • Pay any excess or co-payment required under your private health insurance cover.

If you’re aware of your rights and you fulfil all your obligations, you will probably be able to choose the right hospital and receive successful and stress-free treatment for your condition.

Compare your hospital cover options today

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Tim Falk

A freelance writer with a passion for the written word, Tim loves helping Australians find the right home loans and savings accounts. When he's not chained to a computer, Tim can usually be found exploring the great outdoors.

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