Choosing public or private health systems for treatment

You can choose whether to have your treatment in the public or private health system. You can also choose to have some of your treatment in the private health system (for example, chemotherapy) and some in the public health system (for example, radiotherapy).

This article addresses some of the issues to consider when choosing to have public and/or private treatment.

Factors that may influence your choice

Whether you choose to be treated in the public or private system may depend on a variety of factors, including:

• whether you have private health insurance and, if so, what you are covered for
• where you live and what services are available near you
• whether you are willing to potentially wait a little longer for appointments, tests and treatment
• whether you would like to choose your doctors and treating team
• whether you would like access to a range of allied health professionals such as a social worker, physiotherapist etc (not all of these are available in all private health centres).

Advantages and disadvantages of each system

To help you make your decision about whether to have treatment in the private health system, the public health system or a combination of both, here are some of the advantages and disadvantages of each.

Advantages of the public health system

• You will not be charged for most of your treatment and care.
  You are more likely to have a multidisciplinary team (MDT) coordinating your care.
• You are more likely to have access to a breast care nurse, social worker, physiotherapist and other allied health professionals.
• You are more likely to have all of your treatment team in the same place.

Disadvantages of the public health system

• You will be treated by doctors nominated by the hospital – you cannot choose your doctors.
• You may see several different doctors during the course of your treatment.
• You may have to wait longer for appointments and treatment, but this should not affect the outcome of your treatment.
• You may have to share a room while having your hospital treatment, e.g. surgery.

Advantages of the private health system

• You can choose your specialists and the hospital in which you wish to be treated.
• You will generally see the same doctor at each appointment, giving you continuity of care.
• Timelines for treatment are generally shorter.
• Depending on your level of cover, you may be able to stay in a private hospital and have a private room.

Disadvantages of the private health system

• You could be faced with substantial out-of-pocket costs for your treatment, e.g. you may have to pay an ‘excess’ or gap for your surgery.
• Private health insurance only covers inpatient procedures, so you will not be covered for any treatment as an outpatient, e.g. radiotherapy, radiology, pathology tests and visits to specialists in their rooms. While these do attract Medicare rebates, the rebate will not usually cover the whole fee.
• You are less likely to have access to allied health professionals such as a social worker or physiotherapist at the hospital where you are having treatment.

If you have private health insurance

You can be treated as a public (Medicare) patient in a public hospital even if you have private health insurance; however you will need to let your doctors know that this is your decision. In this case you will be treated by doctors nominated by the hospital and you will not be charged for most of your treatment and care.

If you have private health insurance you can also choose to be treated as a private patient in a public hospital. You will usually be able to choose your doctors and, in some public hospitals, will have no out-of-pocket expenses (the excess is waived). If you would like to consider this option, talk to your treating doctor and hospital about what they offer.

If you have private health insurance and choose to be treated in a private hospital you can choose your specialists.

Depending on your level of cover, you may have out-of-pocket costs or have to pay a ‘gap’ fee for hospital stays and for treatment by specialists. Private health insurance only covers inpatient procedures, so you will not be covered for outpatient care such as radiotherapy, radiology, pathology tests and visits to specialists in their rooms. While these do attract Medicare rebates, they may not always cover the whole fee.

Before you start any treatment as a private patient in a private hospital you may want to get a quote for how much your treatment will cost and find out exactly what is covered by your health fund and by Medicare. You can also talk to your health fund about which treatments are covered by your insurance, what the ‘gaps’ are likely to be, what other services you can claim and how much of the costs will be covered (e.g. drugs that are not covered by the Pharmaceutical Benefits Scheme [PBS], lymphoedema garments, wigs). Read about the PBS. 

Reviewing your private health insurance policy

Following a diagnosis of breast cancer or DCIS, you probably want to proceed with your treatment as soon as possible. However taking time to review your current health insurance policy to make sure that it suits your needs, may save you money and potentially give you greater coverage for some treatments.

Having breast cancer or DCIS does not prevent you from changing health insurance providers or policies, nor can you be refused cover or charged more. If you choose to change to another provider or policy, you will not have to serve the waiting period you have already served, as long as you swap to the same or a lower level of cover.

If you decide to commence private health insurance or choose a higher level of cover, you may have a 12 month waiting period before you are covered for a pre-existing condition (breast cancer or DCIS).

Comparing health insurance policies can be confusing and time consuming. It can be helpful if you have a family member or friend to assist you.

Contact your current provider so that you can discuss your needs and any options available. You can also use an online site that provides insurance comparisons to find out what other health insurance providers offer. You will then be able to make an informed choice about your private health insurance.

For more information about reviewing your private health insurance, read the Beacon article Knowing your rights when it comes to health insurance.

If you don’t have private health insurance

If you don’t have private health insurance you can receive your treatment in a public hospital. Your doctors will be nominated by the hospital and you will not be charged for most of your treatment and care.

You can also still choose to be treated as private patient in a private hospital, however, the costs can be high. Your doctors and treating centre will be able to tell you what the charges are likely to be.

Financial assistance

The financial costs associated with treatment and care can be substantial. You may be eligible for financial assistance provided by federal, state and territory governments and/or community organisations.

• Read about the PBS.
• Read more about Centrelink payments.