Public vs private healthcare

Public patient in a public hospital

Because public health is available to every eligible Australian, those with private health insurance can still choose to be treated as a public patient in a public hospital. As a public patient, your treatment is covered by Medicare. This includes all eligible accommodation, doctor services, diagnostic tests and medications. Drawbacks of being treated as a public patient include:

• Your doctor is allocated to you by the hospital.
• You might not have the option of a private room.
• You're subject to more extensive waiting lists for elective surgery.

What's included as standard in a public hospital?

As a public patient in a public hospital, you'll not usually pay anything for your hospital treatment, as everything will be covered by Medicare. Services covered include:

Private patient in a public hospital

The main advantage of going private in a public hospital is that you get to choose your own doctor if they are available. However, you might still have to share a room, as private rooms are reserved for those who need them most.

Being treated as a private patient in a public hospital is sometimes necessitated by location. For example, if you live in an area that does not have a private hospital with which your health insurance fund has an agreement.

If you're a private patient in a public or private hospital, Medicare will cover 75% of the Medicare Benefits Schedule (MBS) fee for these services, leaving you with 25% to pay. Whether you have out-of-pocket expenses or not will depend on the level of hospital cover you have and whether your health fund has a gap agreement with the hospital in question, in which case the remaining 25% may be covered by your health insurance. It will also depend on whether your chosen doctor charges more than the MBS fee and if so, whether your insurance will cover this.

At the time of admission, you will be asked if you wish to go private in a public hospital. Some public hospitals will encourage you to choose to be treated as a private patient, as they can make more money – but it's up to you.

Private patient in a private hospital

If you have a higher level of health insurance that entitles you to be admitted as a private patient in a private hospital, you have the advantage of being admitted faster for elective treatments than in the public system. You'd also be able to choose your own doctor and are more likely to get a private room rather than sharing.

The proviso to this is that the private hospital you're being admitted to has to have an arrangement with your doctor allowing them to treat private patients and has the accommodation and services available at the time you wish to be admitted.

Questions to ask before being admitted

Before you go into hospital as a private patient, you need to find out the estimated cost of your treatment and whether your health insurance policy will cover most or all of the costs. Be sure to confirm the following with:

• Your health fund. Speak with your health fund about your level of cover and whether your procedure is included, any waiting periods or exclusions that may apply and whether they have a gap agreement with the hospital you will be treated at.
• Your treating doctor. Make sure you ask your doctor for a written estimate of the services for that you will be billed for, whether there are any additional charges, whether they are participants in your health fund's gap agreement and if there are any other costs not covered by Medicare (e.g. pharmaceuticals or diagnostic tests).

Are ambulance costs covered?

Medicare does not cover the cost of emergency or other ambulance services, except in some states (Queensland and Tasmania) and in some circumstances (pensioners and low income earners in NSW and ACT).

So this is another area where private health insurance can help. Most health funds include cover for emergency ambulance transport, which can be many hundreds of dollars if you are required to pay the bill yourself.