If you've got private health insurance, the choice to use it in a public hospital is your own

You arrive at your local public hospital for treatment. The hospital staff ask for your name, date of birth and address. They ask if you have Medicare and private health insurance. Then they ask if you would like to be admitted as a public or private patient. You’re unsure. You’re left wondering whether this decision will affect the care you receive.

Almost all patients will be asked, either verbally or via a standard admission form, whether they have private health insurance and wish to use it.

In our research projects we’ve spoken to Australians with private health insurance who have received treatment in public hospitals. Many people say they find it difficult to decide whether to be a private or public patient. They are unsure of the benefits and costs, and where to find this information.

Read more: Are private patients in public hospitals a problem?

Public hospitals have recently been criticised for allegedly pressuring vulnerable patients to use their private health insurance.

It’s important to note that opting to go private in a public hospital is solely your decision, and will not affect the quality of care you receive. Public and private patients have the same access to public hospital services.

Under the National Health Reform Agreement, all Medicare cardholders have the right to be treated in public hospitals for free as public patients. The cost of accommodation, meals, health care and other treatment-related fees is covered by Medicare.

Why do public hospitals ask the question?

Public hospitals are treating a growing number of patients every year, with increasingly complex needs and health conditions. In this environment, hospitals are expected to do more with less.

People who use their private health insurance benefit the public hospital because some of the funding needed for care comes from private health insurers, rather than hospitals relying solely on the allocation provided by the government via Medicare.

Hospitals say funding received from privately insured patients goes towards infrastructure, research, specialised equipment and other service improvements.

Australians with private health insurance are using their cover when admitted to public hospitals more than they used to. In 2004, an estimated 6.8 per 1,000 admissions to public hospitals were private patients; by 2014, this increased to 22.7 per 1,000.

Meanwhile, insurance companies argue increased use of private health insurance for public hospital care is contributing to rising premiums.

Read more: Do you really need private health insurance? Here's what you need to know before deciding

Why do people choose to be private patients?

Australians might choose to be a private patient in a public hospital for many reasons.

The excess or co-payments applied by private health insurance providers for treatment in private hospitals may be discounted or exempted by public hospitals. So there may be no out-of-pocket expenses for private patients, depending on the type and length of admission.

As a private patient you may be able to choose your doctor, if they have a “right of private practice” at the hospital where you are admitted.

Patients also indicate that they choose to be admitted as private patients because this is a way of giving back to the public hospital. In our research, patients recounted being asked “would you like to help the hospital out?”; the suggestion being they would be doing so by using their private health insurance.

The idea of helping the hospital is also promoted on hospital websites when information is provided. Some patients said they did not want to take public resources away from those who rely on the public system for care.

Read more: Which are better, public or private hospitals?

Some patients in our research saw supporting the hospital as advantageous to them personally as a future patient: “a benefit to the hospital […] is beneficial to me in the long run,” one respondent said.

People also choose to be a private patient because they believe they will get privileges for doing so. Many hospitals offer expressions of gratitude to private patients such as access to television, coffee vouchers or free parking.

Some offer single rooms to private patients, but priority is given to patients who are very ill or infectious.

Some patients in our research said they were surprised they did not receive quicker or better quality care as private patients: “Being a private patient in a public setting made no difference. The level of care was the same,” one said.

Final things to consider

Publicly accessible information about being a private patient in a public hospital, including information about payments and any potential out-of-pocket costs, varies greatly between hospitals and states, and can be hard to find.

While many public hospitals guarantee there are no costs associated with being a private patient, this is not the case for every public hospital. We advise the following:

1. if you are eligible for Medicare benefits, you are not obligated to use your private health insurance in order to receive the same quality of care provided to all patients – it is your choice

2. check with your private health insurance fund about whether you will be charged for any services received

3. check the hospital website for information about using private health insurance

4. if you are unsure about the costs and benefits of using your private health insurance, say so. Many public hospitals have staff called patient liaison officers who are there to answer your questions.