Taking care of your health is important, so when you need care, understanding how to make informed choices is essential. If you need to go to hospital, navigating the different components of Australia’s Healthcare System can be challenging and confusing, when you just need to focus on your health.
So, let’s break it down and take a look at the parts of the system, and how it all works together.
The healthcare system at a glance
Australia’s Healthcare System is one of the most comprehensive in the world; offering a range of services from general and preventative health, through to treating more complex conditions, that may need a specialist, or hospital care.
The system has two major parts: the public health system, and the private health system. When you need health care, you could access it through one of two systems, or a mix of both.
Let’s explore what they look like:
The public system is made up of number of components, including public hospitals, community-based services, and affiliated health organisations largely owned and governed by state and territory governments. The Australian public accesses care within the public health system for free or at a lower cost through Medicare (funded by tax).
The private system includes health service providers that are owned and managed privately, such as private hospitals, specialist medical and allied health, and pharmacies.
The services you access through the public system are funded by local, state and federal governments, but the services you access through the private system are funded by a combination of government and private entities, including:- Private health insurance premiums – paid by customers
- Private health organisations
- People paying directly for private treatment
- Government incentives on private health insurance
- Other government and private funding
In the lead up to, and during a hospital visit, health professionals, including doctors and specialists, can provide treatment through either the public or the private system.
There are a few areas of the healthcare system you’re likely to encounter as you move through life, especially if you need to go to hospital in Australia.
Who delivers healthcare
Medical professionals
Doctors, and in particular general practitioners (GPs), are often your starting point when it comes to health and care.
When you first meet with them (this is sometimes called a consultation), they will assess any problems you may present with, and try to treat your immediate health concerns.
If needed, they can also organise relevant tests to inform a diagnosis, and can refer you to specialist, hospital or alternate care.
For example, if you’ve got a heart condition, they may refer you to a cardiologist.
Find out more about what you can expect when visiting a specialist.
Your GP may also refer you to what’s known as an allied health professional. These are trained professionals who can help manage physical and mental health, such as physiotherapists and psychologists.
Public and private hospitals
If you need to go to hospital in Australia for an operation or treatment, there are different types of hospitals.
Public hospitals
Public hospitals provide high quality medical care and provide care at low or even no cost to people with access to Medicare. They are usually where you go if you have an emergency.
If you need non-urgent treatment, and choose to be a public patient, you may need to wait longer until a space becomes available, you won't be able to choose your doctor (you'll be looked after by the doctor on-call for your health issue or condition), and may be in a shared room with other people while you recover.
Public hospitals are funded and by the government, but also get funded by health insurance when patients choose to use their private cover in a public hospital.
Private hospitals
Private hospitals are owned and operated by the private organisations but licensed and regulated by the government. Typically, you’ll get:
- Choice as a private patient regarding aspects of your care, like choosing your doctor
- Reduced waiting time for elective or planned surgeries
- The choice of a private room (if available and medically appropriate)
You can also be treated as a private patient in a public hospital, treated by your choice of doctor.
Find out more about your hospital options here.
Who pays for healthcare?
Depending on how you use the healthcare system, funding comes from the government, as well as private health insurers, and sometimes – from you.
Medicare
Medicare is the government’s scheme to give the public access to health care (paid through your taxes), and it covers:
- Treatment as a public patient in a public hospital
- 75% of the fee on a government list (MBS) for doctors’ services in hospital if you’re a private patient
- All (what’s known as ‘bulk billing’) or some of the cost of going to a GP or specialist
- Some (but not all) tests and examinations your doctor orders for you
- Reduced cost on some prescription medications, if they are on a government list called the Pharmaceutical Benefits Scheme (PBS).
There is a list of services subsidised by the government. Each has a fee that the government says is appropriate to charge for that service. This list is called the Medicare Benefits Schedule (or MBS). You can see the list here.
Private health insurance
Private health insurance is an optional cover many Australians take out to give them more choice when it comes to their healthcare. You can choose a level of cover to suit your needs.
Private health insurance covers things like:
- Hospital treatment: Once you are admitted to hospital, private hospital cover will help pay for the costs of treatment and your stay.
- General treatment: Also called ‘Extras’, or 'Ancillary' this depends on your policy but can include dental, optical and physiotherapy treatments, for example.
- Ambulance: You could get cover for emergency, and sometimes non-emergency transport and/or treatment. In some states, an ambulance may already be covered or cover can be purchased by a subscription directly from the provider.
Healthcare can be expensive. If you need to have treatment, learn more about options for funding your treatment.
If you’re a Bupa member, you can learn more about how health insurance works at Bupa, in Bupa’s Important Information Guide.
It’s easy to feel overwhelmed by all of the information, so spend some time talking with your family and healthcare provider about what’s going to be best for you.
This guide looks at how hospital treatment works in Australia, for people with access to Medicare. If you’re visiting from overseas, check out our Visitor’s Guide to the Australian Health System.