Public and private: what's the difference?

So what is the difference between a public and private patient? The short answer is:

• A private patient is someone who chooses to use their hospital insurance to fund their treatment.
• A public patient is someone who goes to a public hospital and relies on Medicare to fund their treatment.

But the devil is in the detail. Your choice—public patient or private patient—will shape your hospital experience. Here’s a snapshot of the differences between public and private patients.

What is a private patient?

If you use your hospital insurance to fund your treatment, you are considered a private patient.

As a private patient, you can go to a private or public hospital.

The level of control you have over your stay changes depending on your hospital choice.

Private patient in a private hospital

As a private patient in a private hospital, you can avoid the public hospital waiting list and choose when you get treatment. This is particularly handy if you have an upcoming holiday to plan around, or if you need to get back to work quickly.

You can also choose your doctors and your specialist. Plus, so long as it’s covered on your hospital insurance and one’s available, you can stay in a private room.

When you go private, there can sometimes be gaps you need to pay out of your own pocket. These can be things like any excess or co-payment you have on your hospital insurance, or if your doctor or specialist isn’t fully covered by your health fund.

Private patient in a public hospital

If you choose to go to a public hospital as a private patient, public hospital waiting lists still apply.

In terms of cost, private patients in public hospitals don’t often have gaps to pay. If there are any gaps, you’ll pay for these out of your own pocket, much like you would if you went to a private hospital.

As a private patient in a public hospital, you may be able to choose your doctors and specialists but it’s definitely not guaranteed. If you have cover for a private room, you may get one, but only if there’s one available and there’s no one who needs it more than you.

What is a public patient?

If you go to a public hospital and solely rely on Medicare to fund your treatment, you are considered a public patient. In this situation, most of your treatment will be free or heavily subsidised by Medicare.

Even if you have hospital insurance, you can choose to not use it when you go to a public hospital and get free treatment as a public patient instead.

In a public hospital, your choices are limited.

You will generally go to the public hospital closest to your home, and that hospital will assign your doctors and specialists. If your local hospital can’t provide the treatment you need, you’ll be sent to the closest one that can.

If you need elective surgery (for example, a knee reconstruction), you will be placed on a public hospital waiting list.

You won’t have a choice in when you get treated, you simply wait until a spot opens up and the hospital contacts you with a time and date.

Depending on the hospital you attend, the procedure you need, and how urgently you need it, you may wait months and sometimes years to get treatment.

There’s also a chance you get bumped back depending on how urgently you need surgery compared to other patients.

Finally, as a public patient you won’t have the option of a private room—in most cases, you’ll stay in a shared room unless your condition means you need to be isolated (for example, if you’re infectious).

What is a self-funded patient?

If you don’t have private hospital insurance, you can still choose to go to a private hospital for treatment. If you go down this road, you’re considered a self-funded patient.

Medicare doesn’t cover private hospital costs (for example, theatre fees or accommodation), so if you receive private hospital treatment without hospital insurance, you will need to pay for everything out of your own pocket.