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A Guide to Being a Private Patient in a Public Hospital

Megan Fraser Fact Checked Updated: 16 November 2023
Types of Health Insurance

When you are admitted to a hospital, you can choose between being treated as a public or private patient. As an Australian citizen, you can receive free healthcare through Medicare at any public hospital. Even if you have private health insurance, you can still access the benefits of Medicare. However, if you have private health insurance, you may be interested in knowing the advantages of being a private patient in a public hospital.

Private health insurance offers benefits like quicker medical treatment, more doctor and hospital options, and better facilities. But not all procedures are covered, and you may still have to pay out-of-pocket. Whether to choose private or public care depends on your situation and needs. Keep reading for more information on the pros and cons and how to handle public hospital admission.

Key facts

  • Being a private patient in a public hospital offers several advantages, including quicker treatment, more doctor options, better facilities, and the possibility of a single hospital room.
  • Public patients have their expenses covered by Medicare, while private patients have some costs covered by Medicare and the rest by private health insurance.
  • The choice between private and public care depends on individual preferences and requirements.

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The Difference Between Being a Private vs Public Patient

Choosing to be a private patient in a public hospital has some distinct differences. As a public patient, Medicare covers all your accommodation, medical and diagnostic services, doctor and specialist fees, prostheses, and other relevant services. However, you may need help to choose your doctor or access certain perks like a single room.

On the other hand, as a private patient with an applicable Hospital cover policy, Medicare pays up to 75% of your hospital fees, and your private health insurance provider typically covers the remaining costs. You may have more control over planning your treatment, shorter waiting times for elective procedures, and the option to choose your doctor or specialist if available.

Private Patient Public Patient
You can choose your doctor or specialist.The hospital assigns Doctors and specialists.
Access to a single hospital room if available.Room allocation is typically shared with other patients.
Shorter waiting times for elective procedures.Waiting times may be longer for non-urgent treatments.
Additional perks like early discharge and tests.Limited access to certain perks and services.
Possible out-of-pocket expenses due to gap fees.Most services are covered by Medicare with no gap fees.

Benefits of Choosing a Public Hospital

Opting for a public hospital can offer several advantages. Public hospitals generally have access to a broader range of services, making them ideal for those with complex health conditions or needing emergency care. They are typically more cost-effective since Medicare covers most of the expenses.

Public hospitals can be a more practical choice for people living in rural areas, as they often provide essential healthcare services without the need for extensive travel.

Why Choose a Public Hospital Over a Private Hospital

Opting for a public hospital over a private hospital can be a practical decision for various reasons. Here are some compelling factors to consider:

  • Cost-Effectiveness: Public hospitals are funded by the government and provide free or low-cost medical care to patients. Choosing a public hospital can save you significant expenses, especially if you don’t have private health insurance.
  • Medicare Coverage: Medicare, the Australian government’s health insurance scheme, covers most of the costs associated with treatment in public hospitals. You won’t need to worry about gap fees or additional out-of-pocket expenses for eligible treatments.
  • Access to a Broad Range of Services: Public hospitals typically offer a comprehensive range of healthcare services, including specialist care, emergency services, and advanced medical treatments. They are well-equipped to handle complex health conditions and emergencies.
  • High-Quality Care: Public hospitals adhere to strict quality standards and regulations, ensuring patients receive excellent medical care. They have experienced medical professionals and state-of-the-art facilities to deliver high-quality treatments.
  • Emergency Care: Public hospitals are equipped to handle emergencies and critical situations. Public hospitals are well-prepared to provide immediate and life-saving care if you have a medical emergency.
  • No Waiting Periods for Pre-Existing Conditions: Public hospitals do not impose waiting periods for pre-existing medical conditions. You can receive treatment for your condition immediately without any delays.
  • Healthcare for All: Public hospitals provide healthcare services to all Australians, regardless of their financial situation or insurance status. They offer equal access to medical care, promoting a more inclusive healthcare system.
  • Rural and Regional Services: Public hospitals are crucial in providing essential healthcare services to rural and regional communities. They ensure that residents in remote areas can access necessary medical treatments without extensive travel.
  • Public Health Initiatives: Public hospitals often engage in public health initiatives, promoting community health and preventive care. They work to improve overall population health and well-being.

Case Study: Sarah’s Hospital Dilemma

Meet Sarah, a 35-year-old marketing executive who sustained a knee injury while playing sports. Her doctor suggests surgery to fix the damaged ligament and offers her the choice of being a private or public patient for the operation. Sarah has private health insurance from her employer, but she’s uncertain about what to do.

Option 1: Private Patient

Sarah, being a private patient, has the benefit of having her private health insurance cover a part of her hospital expenses. Additionally, she has the freedom to choose the orthopedic surgeon of her choice, and if available, she may even get a private room for added comfort during her stay. Sarah is particularly keen on this arrangement as she has heard excellent feedback about a specific specialist.

It is worth noting that even though she has private health insurance, she will still have to pay an excess fee of $750 upon admission. Moreover, there may be additional out-of-pocket expenses depending on the surgeon’s fees and any additional services that she may require during her hospital stay.

Option 2: Public Patient

If Sarah decides to become a public patient, Medicare would cover all her hospital expenses without any excess or out-of-pocket costs. Although she won’t be able to choose a specific surgeon, she can trust that the public hospital has capable orthopedic specialists who can perform the procedure. However, there is a possibility that she may have to wait a little longer for her surgery as public patients are prioritized based on their level of urgency.

Sarah’s Decision

Sarah has thought it over and has decided to opt for being a private patient for her knee surgery. She values the option to pick her preferred surgeon and the possibility of having more comfortable accommodations during her hospital stay, which outweigh any financial worries. Sarah is willing to pay the extra fees and any other expenses to be certain that her operation is being carried out by the surgeon she trusts.

Sarah got in touch with her private health insurance provider to verify the coverage details and made arrangements for her upcoming surgery. She feels assured that she has made the best decision for her particular circumstances.

Do You Have to Pay Extra for Private Health Insurance?

It’s important to understand that private health insurance comes with expenses. The cost of your health insurance will likely differ based on your individual needs and the policy you select. It’s crucial to examine your choices thoroughly to identify a plan that suits your requirements and finances.

Will I Have Any Out-of-Pocket Costs?

Private health insurance usually covers treatment costs in a public hospital, but some services may not be covered. If you require a specialist who is not employed by the hospital, you may have to pay their full fee. Knowing about possible out-of-pocket expenses can assist you in managing your finances effectively.

Benefits of Having Private Health Insurance

Having private health insurance can be advantageous for those who value flexibility and access to additional services. Some benefits include:

Frequently asked questions

  • Can I be a private patient in a public hospital in Australia?

    In Australia, it is possible to become a private patient in a public hospital. This option offers certain advantages, such as the ability to select your preferred doctor and the possibility of obtaining a private room.
  • Do I need private health insurance to be a private patient in a public hospital?

    While private health insurance can offer additional benefits, you do not necessarily need it to be a private patient in a public hospital. The ability to choose your doctor and enjoy other perks is available regardless of your insurance status.
  • How do I become a private patient in a public hospital?

    To become a private patient in a public hospital, inform the hospital staff about your preference during the admission process. They will guide you through the necessary steps and provide the required forms if needed.
  • Can I switch to being a private patient after admission?

    In some cases, it may be possible to switch from a public patient to a private patient after admission, but this will depend on the hospital’s policies and availability. It is best to discuss this with the hospital staff as early as possible.
  • What are the costs involved in being a private patient in a public hospital?

    As a private patient in a public hospital, you may be charged for medical services, hospital accommodation, and any additional amenities or services you choose. These costs can vary, so it’s essential to inquire about the fees and potential out-of-pocket expenses beforehand.

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