Paying for healthcare

Most healthcare systems include many types of providers and insurers, both public and private. What you pay for care depends on the kind of treatment you are getting, whether you have private health cover, and what government services you are eligible for. Some of your costs may be covered by a public health scheme, some by a private health insurer (if you have one), and you may need to pay the rest yourself.

Doctors, specialists and other healthcare providers often set their own rates and use different payment models. To avoid unexpected bills, ask before each appointment what you will be charged, what is covered by any public scheme, and what is included in your insurance plan.

Public health insurance#

Many countries run a national public health insurance scheme that helps people access care at low or no cost. Such schemes commonly cover:

• free or subsidized treatment by providers such as doctors, specialists and, in specific circumstances, certain allied health practitioners
• a set portion of an approved fee for services and procedures
• treatment and accommodation for public patients in public hospitals.

Public schemes usually do not cover services that are not clinically necessary, such as television, internet or other optional hospital extras. Exactly what is covered, and how much, varies from place to place.

Private health insurance#

Private health insurance can give you more control over your treatment and help with costs that a public scheme does not cover. People often take out private cover so they can choose their own doctor or hospital, have a private room, or reduce waiting times.

The two main types of cover that insurers tend to offer are:

• Hospital cover - towards costs such as hospital accommodation, theatre fees and doctors’ fees.
• General (or extras) cover - towards services such as dental, allied health and home nursing.

Having private insurance does not stop you from choosing to be treated as a public patient in a public hospital.

Hospital costs#

You can often choose to be admitted to a public hospital as either a public or a private patient.

• Public patients generally have emergency, outpatient, doctors’ and specialists’ fees, hospital accommodation, theatre fees and in-hospital medicines covered by the public scheme.
• Private patients in a public hospital still have their primary healthcare covered by the public scheme, but their hospital accommodation, theatre fees and doctors’ fees are not. These are paid by the patient or their private insurer.

Fees for treatment in private hospitals are typically covered partly by a public scheme and partly by private insurance, with the balance paid by the patient.

Paying to see a doctor#

Visits to a primary care doctor may be covered partly or fully by a public scheme, with the decision about how much is covered often left to each doctor or clinic.

• Public schemes commonly reimburse doctors at a set rate. If a doctor charges more than that rate, the extra is passed on to you as an out-of-pocket cost.
• Where a doctor bills the public scheme directly and accepts the scheme’s payment as full payment, the visit is free to you. Some doctors do this all the time, some only on certain days or hours, and others not at all.
• Longer consultations may cost more.

To avoid surprises, call ahead to ask how the clinic charges. Children, pensioners and concession card holders are sometimes treated at no cost, but there is no single standard, so check before you book.

Paying to see a specialist#

Specialists’ fees vary a great deal and depend on whether you are seen in a public hospital or a private clinic, the individual specialist’s fee structure, and your eligibility for reimbursement or private cover.

Ask your specialist how much it will cost upfront and whether there are likely to be further costs. You may also want to ask whether they accept your private health cover. Where you see a specialist as a public patient in a public hospital, the service may be billed to the public scheme, making it free to you. If you have private insurance and choose to be a private patient, you can usually choose your own specialist.

Medication#

Many countries run a scheme that subsidizes a wide range of approved prescription medicines, making them more affordable. How much you pay can depend on whether you hold a concession card or have reached an annual spending threshold, after which medicines may be further discounted or supplied free.

If your family spends a lot on medication over a year, ask your pharmacist whether any safety-net arrangement applies. When buying medicine, you can ask for a generic brand; generics have the same active ingredients and are subject to the same regulatory approval. If a medicine is not on an approved subsidy list, you will pay the full price, and prices vary between pharmacies, so it can be worth shopping around.

Dental care#

What you pay for public dental care depends on your situation and the treatment you need; some people are eligible for free treatment, while others pay a fee. Free or subsidized public dental care is often available for groups such as children and young people, concession card holders and their dependents, people in care, and those experiencing financial hardship. Some schemes also provide a set dental benefit for eligible children.

Private dentists set their own fees, which vary with the dentist and the treatment. Dental costs can be offset by dental insurance, offered under many private policies or as an extra. The two main types are:

• General dental - usually covering cleaning, removal of plaque, x-rays and smaller fillings.
• Major dental - usually covering orthodontics (braces), wisdom teeth removal, crowns, bridges and dentures.

Emergency dental services are available through hospital and community dental clinics. The cost depends on your situation and the treatment needed; you may be eligible for free care or there may be a charge.

Complementary medicine#

A public rebate is sometimes available on certain complementary therapies, such as chiropractic care and acupuncture, so ask when you book. Some therapies may also be partly covered by private insurance; check your policy, as there is often a limit on the number of visits or the total amount you can claim each year. Some universities and training colleges offer discounted treatments delivered by supervised final-year students.

Emergency and ambulance services#

Treatment in public emergency departments is generally free to public patients. On arrival you may be asked whether you want to be admitted as a public or private patient; choosing private means your accommodation, theatre fees and doctors’ fees may be billed to you or your insurer.

Most emergency care is provided in public hospitals, though some private emergency departments operate on a user-pays basis. Ambulance and other emergency transport are not always covered by public schemes, except for some concession holders. Ambulance cover is often available through private health funds or as a separate subscription. Schemes may also offer financial help with travel if you live far from specialist services.

Aged care and disability support#

As with other parts of the health system, you may be asked to contribute to aged care costs if you can afford to, but you will always be given the care you need. People on low incomes with limited assets may be eligible for additional help.

In-home support can include household help, personal care, home maintenance, home modification and nursing care. Before services start, a basic assessment works out what help you need and what it may cost, which depends on your income and the services you choose. Community-based options include respite care for carers and day programs that support independence and social connection. If you need more help than family, carers or home services can provide, residential aged care provides continuous supported care, with an assessment determining eligibility and access.

Separate government arrangements often exist to give people with disability access to personalized, ongoing support, including advice, referrals and help accessing community services.

Financial support#

Government assistance and subsidized services may be available if you spend a lot on medical expenses or hold a concession or health care card. Such support can cover areas including dental health, eye care, ambulance travel, chronic disease management, sexual health and aged care. Ask your doctor or the relevant scheme for more information about costs and your eligibility.

Key points#

• What you pay depends on the treatment, your insurance, and which public services you qualify for.
• Public health schemes often cover public-patient hospital care and a portion of doctor and medicine costs.
• Private health insurance adds choice and helps with costs the public scheme does not cover.
• Always ask providers about fees upfront to avoid unexpected out-of-pocket bills.
• Extra financial support and subsidized services may be available for people on low incomes or with concession cards.

Where to get help#