Private health treatment in public hospitals: How it works

Taking out private health cover can give you the peace of mind that should you be in need of treatment, there will be a number of options available. What many policy holders don't understand is how the nuances of using their private health insurance in getting treatment from a public hospital affects them.

There are several considerations that should be taken into account, particularly with reference to how urgent the treatment may be. All Australians are allowed access to free hospital and medical care in a public hospital. If you pay your taxes, you effectively contribute to your own free public hospital care.

However, if you have private health insurance, you can opt to be treated in a private or public hospital.

Emergency treatment

Private health cover may not be the most appropriate option for instances such as emergency treatments. If you go to a hospital as an emergency patient or need immediate treatment, you don't go to a private hospital – normally you go to a public hospital with an emergency department.

For example, if you're in a car accident, have a heart attack or fall over in the street, the first place you will be taken is the emergency department of a public hospital to receive the required treatment.

Choosing a doctor

Private health insurance does give you the option of choosing which doctor you would like to be treated by or whether you would like a private room, but these considerations will only be accounted for after initial public treatment in the case of emergencies. 

After any emergency treatment has been carried out, you've then got the choice of saying that you want to be treated privately, and you can be transferred to a private hospital if your insurance allows for such provisions. You can then pick which doctor you want to be treated by.

It's usually necessary to treat even private policy holders as public patients in the event of an emergency. Therefore, you can't necessarily guarantee that you will have the option to request your own doctor or personal surgeon as it simply isn't practical if immediate treatment is crucial.

Out-of-pocket expenses

If you do indeed choose to be treated as a private patient within a public hospital, there are additional financial barriers to consider. In this event, the medical practitioner or hospital then has the option of charging you out-of-pocket expenses as well.

Non-emergency treatment

There are instances in which it is most beneficial to use private health cover and these predominantly revolve around non-emergency procedures.

If you're planning treatment such as hip replacements, cataract surgery, etc, then you can go straight into the private system as the alternative of public treatment will likely require an extended wait. For example, such treatments may have a waiting list which extends for 12 or even 18 months in the public system.

Finding the right private health insurance can present many pitfalls to even the most informed consumers. If you would like expert, impartial advice the next time you are looking to upgrade, renew or take out a policy, give HICA a call on 1300 44 22 01.