Public and private hospitals – an overview

Australia's healthcare system is made up of both government-funded and private organisations. The federal government pays for the cost of healthcare under the Medicare system.

Public hospital healthcare is free of charge to all Australian citizens and permanent residents.

Private health insurance is optional. Many people think it’s worth having and choose to get it. There are different types of private health insurance policies.

If you have private health insurance, you can choose to be treated in a public or private hospital.

Public hospitals are owned and managed by the government. Private hospitals are owned by the private sector but are still licensed by the government. The costs involved in going to hospital depend on if you are a public or private patient.

If you have a Medicare card, you can be treated as a public patient in a public hospital. Most of your costs will be covered by Medicare.

If you have private health insurance, you can choose to be a private patient in either a public or private hospital. A combination of Medicare, private health insurance and out-of-pocket costs will cover your stay.

Learn more about choosing between public and private care for your pregnancy and birth (Opens in new tab).

Australia's public hospitals provide high-quality medical care for free of charge to anyone with a Medicare number.

Public hospitals are usually easier to access, especially in rural areas. Public hospitals may have better medical facilities for your condition than private hospitals and can usually treat more complex medical situations.

If you are a public patient in a public hospital:

• the hospital will choose your doctors 
• you will not be charged for medical services, hospital accommodation and many other services
• you can have follow-up care in an outpatient clinic run by the hospital

For these reasons, public hospitals are usually the first choice for emergencies or acute (sudden) health issues. Most emergency department and outpatient services in Australia are provided by public hospitals.

If you are admitted (seen and treated) in the emergency department of a public hospital, Medicare will cover your costs. Emergency departments in private hospitals may charge a fee that might be covered by your private health insurance.

If you choose treatment in a private hospital, you may have more options. Here are some examples:

• You may be able to choose your own doctor (some doctors only work in a private hospital).
• Waiting times for elective (planned) surgery are usually shorter.
• You may be able to choose when to book elective surgery, depending on availability.
• You may get extra services, such as a private room.
• Your doctor will usually provide follow-up care in their private rooms.

Can I be a private patient even if I do not have private health insurance?

You can choose to be a private patient in a private hospital even if you do not have private health insurance. You will need to pay for most of the fees yourself, but Medicare will pay for 75% of the schedule fee. 

Medicare is the Australian government's public healthcare system that helps you get a wide range of health services for free or at lower cost. Everyone in Australia with a Medicare number is entitled to:

• free treatment as a public patient in a public hospital, paid for by Medicare
• doctor visits and some medical tests partly or fully paid for by Medicare
• a reduced cost for many prescription medicines, subsidised by the Pharmaceutical Benefits Scheme (PBS)

If you have a chronic health condition or a mental health disorder, you may be able to get some allied health services partly or fully paid by Medicare. Speak to your doctor to see if you are eligible.

Ambulance services are not covered by Medicare. The options differ depending on what state or territory you live in. In some, the state or territory government pays for ambulance services. In others, you can pay privately for an ambulance. Some private health insurance policies cover ambulance services. 

If you are new to Australia, you can check with Services Australia (Opens in new tab) to see if you are eligible for Medicare or other benefits.

To find out more about what is covered by Medicare, visit Services Australia — Medicare costs (Opens in new tab).

Private health insurance may cover services that Medicare does not.

There are different private health insurers in Australia that offer different levels of cover. It’s important to check what is and is not covered by your policy before making healthcare decisions.

Private health insurance can be divided into 3 types of cover:

• hospital insurance — for treatment in a public or private hospital
• general treatment insurance — for treatment outside hospital that is not generally covered by Medicare, such as dental or allied health services. Different policies include coverage of different services and different levels of cover.
• ambulance cover — may be included in your hospital or general treatment cover, or separately

If you need to go to hospital, most private hospital insurance policies let you choose:

• your treating doctor or specialist
• to have treatment as a private patient in a private or public hospital

Depending on your policy, there may be hospital costs that your private insurance does not cover. You may also need to pay an out-of-pocket amount (called an excess) towards your hospital costs.

It is important to know that health funds have a waiting period after signing up before you are covered by the policy. Check with your fund about costs that are and aren’t covered before you choose care in a private hospital.

If you have private health insurance, you can still get free care in a public hospital. For more information on claiming Medicare when you have private health insurance, visit Services Australia — Private health insurance and Medicare (Opens in new tab) website.

If you are admitted to a public hospital, you can let the hospital staff know that you would like to be a private patient. If you choose to be treated as a private patient in a public hospital, you can:

• get treatment from your own doctor
• have a single room, if one is available 
• go to a private hospital for follow-up care
• have outpatient care by the same doctor in their private rooms

If you are a private patient in a public hospital, you will pay for your hospital accommodation, surgical theatre fees and doctors' fees. Some of these may be covered by your private health insurance. Medicare will pay part of your doctors' fees.

Deciding if to go to a public or private hospital can be confusing, especially when you are unwell.

You may have previous experience in a public or private hospital, or you can take advice from friends, family or your doctor when choosing a hospital. Your choice will also depend on your health condition, where you live and if you want to choose your doctor.

It is important to consider what your private health fund will cover, if you have one. Ask your insurer about:

• any out-of-pocket costs
• waiting periods
• what options are available in your area

Learn more about private health insurance at the Private Health Insurance Ombudsman website (Opens in new tab). The Australian government's Medical Costs Finder tool (Opens in new tab) can help you find and understand the cost to see a GP or medical specialist.

For an overview of private health insurance and the different funds available in Australia, visit the PrivateHealth.gov.au (Opens in new tab) website.

For more information on Medicare benefits for hospital stays and treatments, visit the Services Australia (Opens in new tab) website.

Easy Read resources

You can find Easy Read information about accessing healthcare services, including public and private hospitals:

• Adult health services — Easy Read (Opens in new tab) explains how to access healthcare and what services you may need. 
• When you go to hospital (Opens in new tab) helps you understand what to expect when you are in hospital. 
• MyMedicare: what it is and how to sign up — Easy Read (Opens in new tab) explains how MyMedicare works and how to join.