The medical system: The difference between public and private: Dr Joe Kosterich

Transcript

Like most systems the medical system has its complexities and it can be very confusing for people.

Hi I’m Doctor Joe.

For people not used to the Australian system, and to be honest even for those who are used to it, it really can be a bit of a maze to negotiate. Let’s try and keep things simple.

Your first port of call really for any medical problem or issue will be your general practitioner. Compared to England where people are registered with a GP, in Australia you can choose to see any GP you like and you’re not restricted to seeing one in particular. That said it is a very good idea to find a GP who you like and you’re comfortable with and stick with that GP or at the very least stick with that practice so that there can be some continuity within your care.

Now there are times people may need other services apart from their GP and one of the roles of the GP is to refer you on if need be. For example, if you’re pregnant you’ll probably need to see an obstetrician and you can be referred on. If you need surgery you’ll be referred to a surgeon. This is where it can get a little bit more confusing because there are two systems which is the private system and the public system. In a public system you may be referred to a clinic or a hospital and you will see whichever doctor is there. You don’t have a choice of doctor. That is actually enshrined in the Health Insurance Act.

If you get referred privately then you’ll be referred to a doctor of your choice, or you and your GP can decide who you may like to see, and you will be seeing that doctor. If in turn you then need to be admitted to hospital, that will be a discussion between yourself and your specialist, as to where you may be admitted to hospital and that is also affected by different specialists having what we call admitting rights to different hospitals. So not every hospital can be accessed by every specialist and vice versa, not every specialist has access to all hospitals.

If you need things like x-rays or blood tests then again your GP can refer you for that. If your specialist feels that you need further tests then they can also refer you for those. If you are within the public system it is likely that everything will be done under one roof and that’s because it is hospital based rather than doctor based. If you are under the private system then again, where you end up going to is not necessarily set or fixed.

Billings are necessarily different in both systems. If you are in the public system it is all picked up and covered fully by Medicare. It is a little bit more complicated than that because it is indirectly Medicare through the state government, and that would be the subject of a two or three hour video which we obviously can’t go into today.

In the private system you will receive bills, generally from the hospital and other providers that you have seen. Some of that will be picked up by Medicare, some of it will be picked up by private health insurance and in some instances there may be a gap. A lot of private health insurers are now offering no gap fees and then again, you need to check with your insurer and find out perhaps which specialists may be in that system and which hospitals might be in that system.

So look, there are some complexities that can’t be completely avoided but if you are going down the private system have a chat with your specialist and have a chat with the people at the hospital about how they might be able to help simplify things.

If you’re in the public system then again it’s a little bit simpler. The down side is waiting times are longer. In the private system waiting times are likely to be shorter but expense may be greater. All of these things, it’s a little bit of a trade-off between those different, I suppose competing interests, and ultimately the decision comes down to what you feel is the most important for you.

More information

For more information on Medicare, visit The Medical System – bulk billing & medicare.