It can be a distressing time when you are admitted to a public hospital emergency department due to an accident or unexpected illness. 

Together with seeking medical care, you will be faced with another decision – do I use my private health insurance policy or Medicare to cover my admission?

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

To be privately covered in a public hospital means your private health insurance policy with Doctors’ Health Fund is covering your admission, rather than Medicare.  The admission costs can include your accommodation, theatre and medical fees.

There are genuine and appropriate reasons to receive treatment as a private patient in a public hospital. However, its increasing prevalence in recent years has raised concern around the reliance of public hospital funding on private health insurance, and the impact this is having on premiums.

You may be approached by administrative hospital staff 

Roles have developed within public hospitals and these staff, called patient or client liaisons, are responsible for signing up private patient’s health funds. There has been recent criticism made of the tactics used by these staff, so it is important you have the facts to make your own choice if you are approached: 

  • There is no obligation to use your private health insurance 

If you are eligible for Medicare benefits, you can choose to be covered as a public patient and all medically necessary inpatient costs will be covered by Medicare. You have a right to be a public patient, even if you have private health insurance, and this should not affect the level of clinical care you receive. 

  • The hospital may offer additional ‘perks’ if you choose to be a private patient 

Public hospitals are known to offer additional benefits to patients who choose to use their private health insurance, including free Wi-Fi, food vouchers or parking discounts. Information about being a private patient in a public hospital can be hard to find and varies between hospitals; particularly in regards to more important benefits such as guaranteeing choice of doctor, access to single rooms and specialised follow-up care. It is important to ensure you are receiving the right benefits by using your private health insurance. 

  • You could have out-of-pocket costs if you use your private health insurance 

Your Doctors’ Health Fund policy will apply to your admission if you choose to be a private patient in a public hospital. This means, you may be required to pay any excess, and the doctor who treats you may charge a gap for their services, above what Medicare and the health fund will cover. It is important to remember that if you are covered by our Smart Starter Bronze Plus, any exclusions or restrictions of your policy will apply, so you may not be covered for the services you require.

  • Using your private health insurance can affect premiums

It has been reported that growth in private patient admissions in public hospitals has contributed to approximately 0.5% per annum increase to premiums over the past five years.1 This means, private health insurance premiums can be contributing to services that could be receiving public funding paid through taxes.   

It is important to remember you have a choice when deciding how you will be covered for services in any private or public hospital. Be informed, be equipped with the right questions, and know your rights as a patient. 

If you have any questions regarding how this could affect you, please call our expert Member Services Team on 1800 226 126. 

1The Department of Health. ‘Private health insurance reforms: Private patients in public hospitals.’ www1.health.gov.au. https://www1.health.gov.au/internet/main/publishing.nsf/Content/private-health-insurance-reforms-fact-sheet-private-patients-in-public-hospitals