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When you’re admitted to a public hospital, if it’s not an emergency, you’ll probably be asked if you have private health insurance. If you say ‘yes’, you’ll be asked if you’d like to use your health cover. Should you agree to be a private patient in a public hospital, and what happens if you don’t? We bust the myths, and help you decide.
Image credit: Shutterstock
Myth 1: Being a private patient means you’ll get your own room
Single rooms in a public hospital are allocated according to care needs. You might get a single room as a private patient, but it isn’t guaranteed.
Myth 2: You’ll get better or faster treatment as a private patient
Hospitals are not allowed to treat private patients faster or any differently to public patients. In some cases, however, public hospitals may offer benefits like wi-fi and alternative food menus to private patients.
Myth 3: Public hospital care costs nothing, even if you’re a private patient
As a private patient in a public hospital, you’ll have to pay an excess and co-payments if they apply to your policy. You’ll also have to pay out-of-pocket fees if your doctors charge above the Medicare Benefits Schedule (MBS) Fee. There might also be out-of-pocket costs for radiology and pathology tests. Informed financial consent means the hospital must outline all costs before your treatment – so make sure you ask for a cost breakdown.
Some people choose to go private because they want to choose their doctor, or to reduce the load on the public healthcare system. The reason hospital staff will ask you whether you want to use your health insurance is so the hospital can get funding from your insurer. While staff are allowed to ask if you want to be treated as a private patient, they can’t pressure you – and you’re allowed to say no without any negative impacts to your treatment and care.
Here are the pros and cons of being a private patient:
Public patient in public hospital
Private patient in public hospital
Private patient in private hospital
Medical costs
Free, under Medicare
Possible Medical Gap, depending on what your doctors charge
Possible Medical Gap, depending on what your doctors charge
Hospital costs
Free, under Medicare
Free, under Medicare
Possible Hospital Gap if you’re not in one of your insurer’s Agreement Hospitals
Insurer costs
Not applicable
Excess and co-payments (if applicable)
Excess and co-payments (if applicable)
Accommodation
Shared room
Single room, if available
Single room, if available
Doctor
Whomever is rostered on
Your choice, if available
Your choice, if available
How to decide whether to be a private patient
Here’s what to consider:
Healthcare needs: If your condition is critical, or could become critical (e.g. a cardiac event), you might be better off in the public system, which is generally better equipped for complex and critical situations.
Post-treatment needs: If you need rehab or at-home care after treatment, this might only be available to public patients. As a private patient, you’d need to claim these services on your Hospital Cover policy (if you’re covered) or pay out of pocket.
Budget: If you want to avoid out-of-pocket costs entirely, choose to be a public patient.
Policy: Do you have Hospital Cover that includes the clinical category you need, and have you served the waiting period? If you’re considering being a private patient, contact your insurer to find out whether you’re covered and confirm the excess and any co-payments.
healthslips.com.au does not provide general or personalised advice. Your particular circumstances are likely to impact the accuracy, completeness and relevance of the information or results. Take this into account before making a decision and talk to an expert for financial advice.
Trudie McConnochie
Writer and Researcher
Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.
Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.
Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.
