Since the former Australian government introduced a tax incentive for private health insurance (or should I say, a tax disincentive for not having it), a lot of people now have some degree of private health insurance.
Most people are, however, somewhat confused at what this actually entitles to them- which is understandable given that it's actually quite confusing.
The bottom line is that although there are now private hospitals that have ICU facilities and emergency departments, they really are set up for low-risk elective admissions, while public hospitals are much, much better at handling sick, complex emergency patients. Public hospitals are geared towards prioritising the sickest patients first (thus why waiting lists for non-urgent things are long). Private hospitals are businesses and are geared towards servicing things that are low-risk and high-gain, such as elective surgery or people who aren't that sick.
There are also often costs that are not obvious to those who aren't familiar with the healthcare system and how it works. The public health system is free. The private health system is not. If you are having an operation or procedure, you will have to pay whoever is doing the procedure (surgeon, dentist, gastroenterologist, cardiologist etc) as well as the anaesthetist and the hospital.
What private health insurance entitles you to:
- Usually some or all of your money back if you have an admission or procedure or consultation at a private hospital (as long as it's been long enough since diagnosis, etc). The amount varies considerably from plan to plan and is often capped at a certain amount. There is also often an excess payment for making a claim.
- "Private in Public" status at a public hospital which usually includes the ability to choose your own specialist, have procedures done by your choice of specialist (if they agree) and extra funding is given to the hospital by your insurer.
- If you have at least "Basic Plus" cover or similar, you can usually get covered 2/3 of the cost of dental care, physiotherapy, other allied health services, massage, acupuncture, other alternative healthcare practitioners. This is of course based on reasonable costs- if your practitioner overcharges you or the "reasonable cost" is actually unrealistic then you may not have the whole 2/3 covered.
- Elective (non-urgent, non-emergency) procedures will usually be performed much faster in the private sector. Good examples include varicose vein surgery, tonsillectomy, tendon repair, carpal tunnel release and arthroscopy.
- Transfer to the public system if you cannot afford the private service or run out of money (depending on resources available)
What private health insurance does not entitle you to:
- A single room. Single rooms are usually reserved for infectious, dying or delirious patients.
- Coverage of costs beyond what your plan covers or beyond what the insurance company deems a reasonable cost- there may be a price gap which you would have to pay out of your own pocket.
- Shorter waiting times for emergency procedures in a public hospital. Emergency procedures are prioritised according to urgency of the case. If you have an abscess on your thigh or a cut on your finger, your operation will be delayed if someone comes in from a car crash or is about to die of dead bowel or a woman in the middle of childbirth has a threat to the safety of the baby.
- Automatic transfer to a private hospital if you are unhappy with your treatment in the public hospital. Being admitted to a private hospital requires that your medical condition suitable for the private hospital, that a specialist is willing to look after you there and that there is a bed available for you.
- Inappropriate medical treatment, procedures or tests just because you think they are a good idea. Ultimately all doctors have to adhere to ethical conduct and the Hippocratic Oath, which forbids doing things that are harmful or unnecessary. Being in the private sector does not mean that you are only a customer. You are still a patient, and your doctor is obliged to act in your best interests.
What private hospitals & insurance are good for:
- Elective, low-risk surgery and procedures
- Simple problems and short admissions
- Covering dental care and allied healthcare
- Rehab- physical & otherwise
What private hospitals are not good for:
- Emergencies, critically unwell and complex patients- in the public system there is always a doctor on site and transfer to intensive care or theatre is prioritised for sick patients. Not always the case in a private hospital where there may not be a doctor on site at night time. Additionally, if your stay is complicated in any way, you may end up with large out of pocket costs.
- Trauma. For exactly the same reason. If you fall off a roof, are in a car accident or get stabbed, you are much, much better off in a public hospital where they routinely deal with trauma, sick patients and have the staff to take you for emergency procedures if required.
- Heart attacks, strokes, liver failure, cancer, hepatitis, cyanide poisoning, etc... I think you get the point.
If you choose to go ahead with doing something in the private hospital setting, I'd advise the following:
- Make sure that you know exactly what you are covered for. The insurance company should be able to advise you in advance if you're contemplating an admission under the private system.
- If it comes to having an operation, make sure you get a quote from 1) the person doing the procedure 2) the anaesthetist and 3) the hospital and then go to your insurer to find out what you are actually covered for. A lot of people get stung by the cost of the anaesthetic for the reason that they assume that it's part of the cost or that there will be no gap. In reality a lot of insurers do not pay a lot of money to the anaesthetist, while the anaesthetist actually pays a lot in indemnity insurance due to risk. The gap can be in the hundreds of dollars if not more.
- Discuss the cost of the procedure, the anaesthetic and the hospital with the person doing the procedure if you can't afford it. They may negotiate a different set up or doing it via the public system. Certainly they can't help you if they don't know that you are going to have financial problems.
- Public hospitals have a liaison person assigned to deal with "private in public" admissions. They can usually tell you a fair bit about what you are and are not covered for and entitled to. At the very least they can tell you who to talk to.
Whew. Hope this helps!