What’s the difference between public and private emergency departments and what are the costs?

Posted: Jun 06 2022

Emergency department

Most people at some stage in their life, will require a visit to hospital for themselves or a loved one in an emergency. All Australian citizens and residents are entitled to use public hospitals for free as we all contribute to our healthcare system through taxes. But in some cases, people choose to go to a private hospital’s emergency department for the convenience of location, or seeing a particular specialist and using private hospital facilities if they need to be admitted.

Here, we explore the differences between public and private emergency departments and what the costs are, so you can be more confident about when you might choose to go to a private hospital for treatment, and avoid surprises knowing what your out-of-pocket costs could be.

If you are experiencing a life-threatening emergency, call 000


Public v Private (Emergency Departments)

Emergency Departments (EDs) are the place to visit for unplanned, urgent and severe injuries and illnesses. They are less suitable for less serious events where going to a doctor’s clinic would be more appropriate.

Whether you choose to go to a public or private hospital emergency department can be a matter of preference, what you value and how sick you are– some people would choose to pay more for a shorter wait time. It’s all about making an informed choice when and if you can.

Generally speaking, the differences between public and private emergency departments are:

Public hospital emergency departments

Private hospital emergency departments
  • open 24/7
  • busier
  • larger emergency department that deals with many serious accidents and emergencies
  • have longer waiting times
  • free to attend (costs are covered by Medicare)
  • usually only open during prescribed hours
  • can sometimes be less busy or quieter
  • often have shorter waiting times
  • more expensive (medical consultancy or facility fees often charged, plus gaps for investigative tests such as x-rays, blood tests)
  • hospitals themselves may be more specialised in certain areas
  • may have more control over treating specialist or surgeon if required to be admitted

What will I pay?

Care provided in a public or private ED is considered an outpatient service. Whether you attend a public or private ED, this outpatient service is covered by Medicare. However, in the case of a private hospital, you may be charged additional fees such as an emergency department facility fee or medical consultancy fee which is your out of pocket gap for that service. There may also be a gap if you require investigative tests whilst in a private hospital ED for things like pathology or radiology. These fees are not claimable on your health insurance as it is an outpatient service.

Public emergency departmentPrivate emergency department
Does Medicare cover claims?Yes – all costs covered by MedicareSome costs covered by Medicare, but you may be charged additional fees.
Out of pocket costsNoneMost private hospitals in Adelaide have a fixed out of pocket fee around $400 such as:


$400 – Ashford Hospital
$350 for pensioners and health care concession card holders.

$430 for most patients at Calvary Adelaide

Plus gaps for investigations such as xrays, blood tests

When can I use my private health insurance?

Private health insurance does not cover treatment in a private hospital emergency department as these are considered to be outpatient services, which by law are unable to be covered by private insurance. However, if you are admitted into the hospital for further medical care, you then become an inpatient. This is where you can use your private health insurance. If you are being admitted, just because you have private health insurance doesn’t mean you have to be admitted as a private patient, this is your choice.

ScenarioCan I use my private health insurance?
1. You present at a private hospital emergency department with a broken arm. You require an x-ray and plaster cast.No - these are considered outpatient services and are covered by Medicare only
2. You present to a private hospital emergency department, and your broken arm requires surgery. You are transferred to a ward and formally admitted to the hospital.Yes – once you are admitted you are considered an inpatient, and this is where your private health insurance kicks in. You are still required to pay the emergency department fees before you are admitted.

General tips when visiting an emergency department

So you’ve chosen which hospital you’re going to attend, here are some tips to keep in mind. Remember, it is important to use good judgement when seeking care from an emergency department and only visit if it is an emergency.

Getting there

No matter whether you choose a public or private hospital, you have a few options when it comes to getting to the emergency department. Depending on your condition, you may be able to ask a friend or family member to drive you, or take a taxi.

If you’re wanting to visit a private hospital emergency department, and are in a position to do so, it’s a good idea to call ahead to ensure that the facility can take you before you make the journey. Many private hospitals will also detail the types of emergencies they will take on their website, with an estimated wait time able to be found online for most private hospitals.

If you require an ambulance, being driven by ambulance to the emergency department is not a free service. If you have ambulance cover, either as part of your private health insurance or an SA Ambulance Cover membership, then you will be covered for this cost, but limits may apply. It is also important to note that SA Ambulance Service have some policies on particular conditions that mean they need to take you to the nearest hospital, but for less urgent care, you can request them to take you somewhere in particular.

If you are experiencing a life-threatening emergency, call 000

What to bring

  • Medicare card
  • Regular medications, if you can
  • Doctor’s details
  • If visiting a private hospital, your Health Partners Card in case you need to be admitted

Note: If you have an Emergency Medical Information Book, make sure it’s located in an easy to find spot (e.g. your fridge) and up to date in case of emergency.

What to expect

On arrival you will be assessed by a nurse who will triage your condition based on the information you provide. You will be seen as soon as possible according to the severity of your illness or the urgency of your requirements based on this triaging by nurses, and not in order of attendance. If another patient comes to the emergency department with a more serious condition while you are there, you may be required to wait.

Before you leave

Make sure you fully understand the treatment you have had and know when to take any prescribed medication. Confirm if and when you need to have a follow up appointment with your GP and ask about a medical certificate if you need one.

Other services

The decision to attend an emergency department comes with stress and uncertainty, it often happens when you least expect it. Give yourself a head-start by being aware of the options around you and knowing what services are available for you and your family.

If you are unsure about whether to visit an emergency department, or need further advice, there are also virtual clinics and services like Healthdirect and the Women’s and Children’s Hospital Child and Adolescent Virtual Urgent Care Service that can help. These services can connect you with a registered nurse or doctor virtually, who can provide further guidance.

Remember if you or a loved one are experiencing a life-threatening emergency, call 000

For more information on navigating the hospital journey, you can access Health Partners Hospital Support or call us.

Posted: Jun 06 2022

Disclaimer

The information contained here is of a general nature and does not take into account your personal medical situation. The information is not a substitute for independent professional medical advice and is not intended to diagnose, treat, cure or prevent any disease or used for therapeutic purposes. Should you require specific medical information, please seek advice from your healthcare practitioner. Health Partners does not accept any liability for any injury, loss or damage incurred by use of or reliance on the information provided. While we have prepared the information carefully, we can’t guarantee that it is accurate, complete or up-to-date. And while we may mention goods or services provided by others, we aren’t specifically endorsing them and can’t accept responsibility for them.

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