Public or private healthcare: understanding your options

Trying to decide between public and private healthcare? Here’s all you need to know about public and private healthcare cover, and how to get the best care that’s right for you.

Public healthcare

In Australia, we’re lucky to have access to excellent healthcare, hospital and community-based medical facilities, and highly trained health professionals when we need them.

Under the publicly funded universal healthcare system, Medicare, Australians can access a wide range of medical services at little or no cost.

Medicare subsidises visits to general practitioners, medical specialists, diagnostic imaging like X-rays, and pathology services such as blood tests.

It also heavily cuts the cost of prescription medicines through the Pharmaceutical Benefits Scheme.

Under Medicare, Australians have access to treatment in public hospitals for as long as they need it. It also subsidises 75 per cent of the fee for treatment of private patients in both public and private hospitals.

While Australia’s healthcare system gives us affordable access to world-class medical care when we need it, there are also some limitations. These mainly relate to hospital admission wait times and choice of doctor or specialist, which are some of the advantages of having private health cover.

Understanding private hospital cover

Before deciding what’s right for you, it’s important to know that there were some important changes to private health insurance in April 2019.

The government introduced changes to standardise private hospital health insurance categories and policies across all health insurance companies to make them easier for consumers to understand.

Under these changes, all health insurance hospital policies now have to fall into one of these tiers: Gold, Silver, Bronze or Basic. Each tier is now required to cover minimum medical categories, no matter which health insurer offers it.

The lower the tier, the fewer medical categories you have access to. For example, Gold covers 38 categories, while Basic covers just three.

For example, a Silver policy from one insurer will have the same minimum level of cover as a Silver policy from other insurers.

Categories can also have a ‘plus’, which means it has some extra cover, but not enough to bring it into the next tier above.

The new system allows consumers to compare health insurance products quickly and easily, helping you decide which one is best for you.

When you want choice

While Medicare provides subsidised access to excellent healthcare, you’re not able to choose your own doctor, where you receive treatment (apart from presenting to an emergency department) and when you’re treated.

You may want the option of choosing which doctor you see, which hospital you go to for treatment, or simply having more flexibility around getting an appointment sooner rather than later.   Health insurance allows you to choose your own doctor or specialist, and then be looked after by that same doctor – providing continuity of care – at the hospital of your choice.

Private health cover also helps you to avoid public hospital queues; which is why a large proportion of elective surgery in Australia is done in private hospitals .

According the Australian Institute of Health and Welfare, in 2017-2018 the median waiting time for elective surgery in public hospitals was 44 days, compared to 22 days in private hospitals.

Health insurance provides more choice and control to individuals over the healthcare services they receive. This becomes particularly important during unexpected or stressful life events, or healthcare situations. Health insurance simply gives you more say in how, when and where you receive your care.

And rest assured that even if you do have private health cover, you still have access to the public health system, such as visits to the emergency department and your GP.

More than hospital cover: allied health and preventative care

Of course, there’s more to looking after your health than just going to hospital. Regardless of how good your health is, we still need to see other healthcare providers – known as allied health professionals - from time to time. Everyone’s needs will be different, but they might include dental, optical, pharmaceutical or physiotherapy services. Extras cover can reduce the cost of these common health services not covered by Medicare.

It can also reduce the cost of preventive healthcare services – such as help to manage your weight, manage stress, quit smoking, or to prevent or delay other long-term health problems.

Extras cover is a great way to be proactive about managing your health. With Extras cover, you can take advantage of the many benefits offered on a wide range of preventative healthcare programs and services to maintain good health and wellbeing.

Find out more

If you’re still not sure what’s right for you, have questions about different policies or simply want to discuss your options, please contact our friendly customer service team Mon – Fri: 8.00am – 5:00pm (AEST) on 1300 499 260.

If you’re considering switching health funds, CUA Health Insurance offers a 4% discount for members who direct debit from a CUA transaction account. If you are between 18-29 years old, you could get an additional 2% discount for every year you are under 30, so contact us to find out more.

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