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In Australia, Medicare, the Government health insurance system, provides universal healthcare. This is available to all Australian citizens and gives access to free or low-cost services such as doctors, outpatient care, hospital care and some dental procedures. Non-Australian citizens who are permanent residents also can qualify for the scheme. Private health insurance allows people greater choices about their healthcare eg which doctor, hospital and type of accommodation, and offers more healthcare options or reimbursable “extras”. For severe ailments however, even private patients are put back into the public health system. The private hospitals are generally just not well enough equipped to cope with critically ill patients and specialised emergency procedures. Examples of conditions that tend to be treated within the public system are head trauma, cancer, heart surgery, organ transplants, dialysis and so forth. Conditions that are commonly taken care of in private hospitals include birth, shoulder and knee reconstructions.
What does private health insurance cover?
Depending on the level of cover, private health insurance covers some or all of the expense of being treated as a private hospital patient in a public or private hospital. Private hospital patients are charged for their accommodation, theatre fees, drug costs and doctors’ fees, as well as many other costs, but their insurance company will reimburse them for large portions of these costs. In addition to hospital care, private health insurance can cover some or all of the costs for many medical services Medicare does not. These may include podiatry, chiropractic treatment, dental treatment and many other procedures. It can also cover more “wellbeing” options such as gym memberships, massage therapies and acupuncture. For elective surgery (non-life threatening surgery) public system waiting lists can be very long. Private patients can simply book into their hospital of choice and be attended to – generally much sooner than is possible for a public patient. An example might be elective knee or shoulder surgery.
Medicare services
When it was first created, Medicare was considered to be the world standard for universal healthcare systems the world over. It was originally engineered to allow for dental care to be introduced at a later stage. Delegates from all over the globe have studied the Australian system as a model for their own public health systems and, though it has been watered down or eroded over time to some degree by less supportive Governments, it remains a system that is by far and a way more fair and accessible than many in other developed nations. (Generally speaking, poorer countries do not have universal health systems – ironically this means citizens of the poorest nations must fund their own medical expenses and most cannot afford to).
Medicare covers a range of medical, hospital and pharmaceutical costs. This includes the full cost of seeing a bulk-billing doctor and most of the cost of seeing a specialist. It also provides benefits for tests and examinations used to treat illnesses, as well as the cost of eye examinations. Medicare covers all the costs for a hospital visit for public patients and most of the costs for private patients. Patients with private insurance, however, get a number of additional benefits. The primary benefit is that people with private insurance can choose their own doctor and have more discretion over when they enter hospital (sooner rather than later).
Private versus public patients
Most people with private health cover are selective about when they inform their carers of their status as a private patient. Sometimes it is cheaper to be treated as a public patient. For people with chronic injuries and special conditions private cover can be worthwhile – you can choose when to have that shoulder reconstruction, get physiotherapy for as long as you need to without having to experience as much financial strain and nominate the surgeon or doctor you wish to have taking care of you. Many young mothers-to-be prefer to be treated as private patients through the pregnancy and birth. Healthy active people can also save money on their everyday expenses, such as sneakers, gym memberships and fitness activities, by taking out private health cover. Fortunately, for the moment at least, the Australian system means most of the best doctors and surgeons available are based in the public hospitals (where they often have teaching roles). These doctors may earn additional income by treating patients in private hospitals on their days off.
Ultimately, the decision to go private is a very personal one and tends to depend on your household income, fitness obligations and whether you are carrying any injuries or experiencing any chronic health conditions.
