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.
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|
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 department||Private emergency department|
|Does Medicare cover claims?||Yes – all costs covered by Medicare||Some costs covered by Medicare, but you may be charged additional fees.|
|Out of pocket costs||None||Most private hospitals in Adelaide have a fixed out of pocket fee around $400 such as:|
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.
|Scenario||Can 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.|
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.
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.
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.
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.
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.
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.
© Copyright Health Partners. 2022 All Rights Reserved.
© Copyright Health Partners. 2022 All Rights Reserved.