Should You Use Private Health Insurance in Public Hospital

Published: January 21, 2019

When admitted to a hospital, one of the first questions you'll be asked is whether you wish to be treated as a private or public patient.

However, every Australian is entitled to free health care in a public hospital under Medicare. If you have private health insurance, you might be wondering what the benefits are of being a private patient in a public hospital, for example, shorter waiting times, and are there any drawbacks.

This article aims to provide you with the information you need to know as a privately insured patient in a public hospital.

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Can you go to a public hospital as a private patient?

Yes, you can go to a public hospital and use your private hospital insurance or choose to self-fund the expenses as a private patient. You might do so because you want to be treated by your chosen specialist/doctor or because a specific surgery cannot be performed at a private hospital.

When going to a public hospital and using your health insurance, be sure to ask:

  • Whether there will be any out-of-pocket expenses, and
  • What benefits you’ll be entitled to as a private patient.

What does it mean to be a private patient in a public hospital?

As a private patient going to a public hospital, you can generally choose the doctor who treats you, get access to a single room when available and enjoy some additional perks. You can decide to either use your private health insurance or pay the extra expenses yourself (self-funded private patient). The public hospital is then entitled to bill both your health fund and Medicare for any costs incurred.

Public vs private patient in a public hospital in Australia

Generally, public hospitals are entirely funded by the Commonwealth and state government, and their services must be provided free of charge to all Australian citizens and most permanent residents.

Public patient

  • Medicare covers all your accommodation, medical and diagnostic services, doctor and specialist fees, prostheses and most other relevant services.
  • Some benefits, like choosing your doctor or getting a single room won't be available.

Private patient

  • Medicare pays 75% of your hospital fees.
  • Your private health insurance provider will typically cover the remaining costs.
  • You might still have some out of pocket expenses.

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Do you have to use your private health insurance in a public hospital?

No, you do not have to show your Health Fund card when at a public hospital. Never feel pressured to use your private health insurance when being treated in a public hospital. Do not be fooled by the incentives of free drinks vouchers and parking or talks of a “donation”.

However, if you do use you’re your private health insurance, maybe because you are not eligible for Medicare, it's your right to ask that they inform you in advance of any extra charges.

Pros and cons of being a private patient in a public hospital

Benefits Disadvantages
Choice of hospital. You might want to have your treatments closer to home. You may have out-of-pocket expenses.
You’ll have more control over planning and booking your elective procedure in advance. If you have a hospital excess on your insurance policy, you may have to pay this when being admitted.
Possibly shorter waiting times for elective procedures, you are thus accessing treatment more quickly. There's is generally no difference in waiting times for emergency procedures.
Choice of treating doctor or specialist, if available, who might also provide follow-up care at their private rooms. If your chosen doctor/specialist charges more than the Medicare Benefit Schedule as a private patient, you’ll have to pay the difference.
Generally, you’ll have the option to transfer to a private hospital if you prefer to continue your treatment there. You'll have to pay extra if your health insurance policy doesn't cover the treatment you're getting. Make sure to confirm that you're covered.
If available, you’ll typically have access to a single hospital room for more privacy. Private rooms are not guaranteed in a public hospital, it all depends on availability.
Perks of free TV, WIFI and daily newspapers if available. Public hospitals charging private patients can lead to an overall increase in health insurance premiums.

Why do public hospitals want you to use your private health insurance?

As a private patient, the public hospital can charge both the Commonwealth Government and your health fund for the accommodation and services rendered. This enables the hospital and treating clinicians to access additional revenue-income. Public hospitals in Australia work on a tight budget, and the money received from the health funds might enable them to keep providing excellent services and contribute to the purchasing of the newest medical technologies.

Frequently asked questions and answers

What’s the cost of hospital stay per day without insurance in Australia?

If you qualify for Medicare and the hospital services are medically necessary, you can be treated as a public patient in a public hospital free of charge, and the hospital will appoint a doctor to you. However, if you do not have Medicare or health insurance you can expect to pay between $300 and $440 per day for shared accommodation in a public hospital.

Is it worth being a private patient in a public hospital when giving birth?

Choosing the hospital, your obstetrician and having a single room for more privacy are generally the top benefits when selecting to use your private health insurance when giving birth in a public hospital. However, you might incur extra costs. Make sure to contact your health fund beforehand.

How do you elect to be a private patient?

Usually, upon admission hospital staff will ask you whether you’d like to be treated as a private or public patient. Their hospital representative will then generally help you fill in the necessary forms.

Can you be a private patient in a public hospital without health insurance?

Yes, you can generally request to be treated as a private patient (self-funded patient), but you’ll be responsible for meeting any expenses or costs incurred during your hospital stay which Medicare does not cover.

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2 Comments

  • Franca Cicerale |

    If you have no private health insurance, can a public patient go to a private hospital for treatment?

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Franca.

      A public patient can still go to a private hospital for treatment. However, Medicare doesn’t cover private hospital costs. If you don’t have private health insurance, you’ll typically be asked to pay the estimated costs when you’re admitted.