As Australians, we’re fortunate to have one of the best public healthcare systems in the world. So when you can get seen in a hospital for free, it can be hard to justify paying a lot of money for private health insurance.
So does this mean you should definitely take out private health insurance? Not necessarily…
How it works when you’re not insured
Without insurance, you are entitled to be seen in a public hospital, for free (provided you have a Medicare card, discussed in more detail here).
This doesn’t mean you’ll necessarily be waiting a year to have heart surgery though. All procedures fall into one of three urgency categories – surgery recommended within 30 days, surgery recommended within 90 days and surgery recommended within 365 days. These categories are used by hospitals to prioritise resources, and you can take some comfort that if the procedure really is urgent, it’s much more likely to fall within the 30 day recommended timeframe rather than the 365 day timeframe.
But these timeframes are a guide. You may seen within a day for a procedure that’s recommended to be performed within a year, and (theoretically at least), vice versa. And the amount of time you need to wait for a certain procedure will vary, as hospital resources and demand fluctuates.
You may find it useful to review the data on hospitals near you. The government’s MyHospitals website is a great tool that allows you to view a particular hospital’s performance by urgency category, specialty of surgeon and intended procedure.
How it works when you’re insured
Even with private health insurance, you will always have the option of being seen as a public patient in a public hospital. But you will also be able to ‘skip the queue’ and schedule surgery sooner through the private system. So if you’re in need of a knee reconstruction and your public hospital waiting list is a year, you can go through the private system and schedule surgery much sooner.
On a more controversial note…
As far as waiting times go, the above explanation is consistent with what you will usually hear from the government and insurers. But recent media reports have suggested that private health insurance provides another benefit when it comes to waiting times. There should technically be no difference between private and public patients in a public hospital for surgery waiting times. By this, we mean that the benefit of private health insurance for surgery waiting times is supposed to be restricted to when you use the private system and arrange your own doctor. However, private patients are experiencing shorter waiting times going through the public system as well – 20 days for privately insured patients compared to 42 days for uninsured patients. While it must be said that this ‘benefit’ is not documented and shouldn’t be happening, it may be worth considering when weighing up the value of private health insurance.