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Find out why people like you have health cover, what your options are and what you might need cover for.
Discover the difference between the private and public hospital systems.
With hospital insurance, your health fund will help cover costs if you go to a private hospital for treatment. As a private patient in a private hospital, you have more control over your health care experience. You’ll be able to choose your hospital, your doctor, avoid public hospital waiting lists and gain access to a private room. That means you can select the best doctor for the job at the hospital of your choice, receive treatment at a time that suits you and gain access to a private room where you can recover in comfort.
If you don’t have hospital insurance, or if you do and choose not to use it, you can go to a public hospital for free. In this situation, Medicare would cover the full cost of your treatment and hospital expenses. The flip side is without hospital insurance you wouldn’t be able to choose your doctor or your hospital. You’d also be allocated a shared or private room based on availability or the severity of your condition. What’s more, if your condition isn’t urgent, you’d be placed on the public hospital waiting list before receiving treatment, even if you’re in pain.
When you go to hospital, you’re either considered a private patient or a public patient.
What is a private patient?
A private patient is someone who chooses to use hospital insurance to help cover the cost of hospital treatment. A private patient has the option of going to a private or public hospital for treatment.
It’s worth noting if you do choose to go to a public hospital as a private patient, public hospital waiting lists still apply. Plus, depending on the type of agreement your health fund has with the public hospital, you may face out-of-pocket costs.
What is a public patient?
A public patient is someone who either doesn’t have hospital insurance, or does and chooses not to use it when they go to hospital. If you go to a public hospital as a public patient, Medicare will cover the cost of your treatment, so long as it’s listed on the Medicare Benefit Schedule (MBS).
If you don’t have private hospital insurance, you can still choose to go to a private hospital for treatment. Medicare doesn’t cover private hospital costs (for example, theatre fees or accommodation), so if you do choose to go to a private hospital without adequate insurance, you should be aware and prepared for associated costs.
So what’s the key difference between going to a private hospital as a private patient, and going to a public hospital as a public patient? Below is a summary of the options you’d have:
A private patient in a private hospital:
Say you’re an expecting mother - you can choose the hospital you’d like to go to when you have your baby.
For example, if you’d like to go to St John of God private hospital for the birth, you can.
A public patient in a public hospital:
Say you’re an expecting mother - you won’t be able to choose where you have your baby. Instead, you’ll be allocated a room at the public hospital closest to your home.
For example, say you want to go to Fiona Stanley public hospital for the birth. If it’s not the public hospital closest to your home, you won’t be able to go there.
If you need surgery and a doctor is recommended to you, you can choose that doctor for your treatment.
For example, if you need your wisdom teeth removed in hospital, you can ask your friends about their experience. Say one friend had a great experience with a doctor – you can contact that doctor and book your treatment with them.
If you need surgery and a doctor is recommended to you, you can’t choose that doctor for your treatment.
Say you need your wisdom teeth removed in hospital and a friend suggests the doctor they saw for their treatment. The doctor did a great job and comes highly recommended. You won’t be able to book that doctor for your treatment. Instead, the public hospital you are referred to will allocate you a doctor for your treatment.
If you need surgery but have other commitments to work around, you can book your surgery at a time that suits you.
For example, if you’re injured and that injury affects your ability to work but isn’t serious enough to warrant a trip to the emergency ward, having hospital insurance means you can get treatment at a private hospital straight away.
Alternatively, you might have a holiday booked or deadlines to meet at work. Provided your surgeon or doctor is available at the time you request, you’ll be able to book your surgery so it doesn’t clash with any of your other commitments.
If you need surgery but have other commitments to work around, you won’t be able to book your treatment at a convenient time. Instead, you’ll be placed on a public waiting list.
Say you’re injured. If your injury is serious enough to keep you at home from work but not serious enough to warrant a trip to the emergency ward, you may have to wait a long time before receiving the surgery you need to treat your injury and get back to work.
Alternatively, you might have a holiday booked or deadlines to meet at work – because you’re on a waiting list, the time of your surgery will depend on how many people are on the list before you.
Say you’ve just had surgery and you’re staying in hospital while you recover; with hospital insurance you’ll have the choice to stay in a private room, where you can recover in comfort.
If you’ve just had surgery and you need to stay in hospital while you recover, unless your condition is serious relative to other patients in the hospital, you’ll likely be allocated a shared room while you recover.
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