spacer State Government Victoria Australia
Victorian Government Health Information header
Victorian Government Website (Victoria the place to be)
spacer
spacer Health Home
Main A to Z Index | Site Map | About Health | Links  
Fees and Charges for Acute Health Services in Victoria
 
Fees Manual Home
Section A: Admitted Patients
Section B: Non-Admitted Patients
Section C: Other Services
Contact Us

Section A: Fees for Admitted Patients

1. Admitted Patients

Patients who are admitted to a public hospital are classified as one of the following:

- public admitted patient;
- private admitted patient;
- Department of Veterans' Affairs patient;
- compensable patient;

- ineligible patient.

2. Public Admitted Patients

Eligible persons who do not elect to be treated as private patients on admission to a public hospital are entitled to receive all necessary medical, nursing, allied health and diagnostic services at no charge. Charges may only be levied on public admitted patients if they are classified as nursing home type patients.

3. Private Admitted Patients

3.1 Overnight Stay Patients

Section 72.1(2) of the Private Health Insurance Act 2007 states that an insurance policy covering hospital treatment must provide at least the ‘minimum benefit’ for that treatment.  The Commonwealth Minister for Health stipulates the minimum benefits payable by private health insurers for shared ward accommodation in public hospitals through the Private Health Insurance (Benefit Requirements) Rules.  The Commonwealth does not set a minimum benefit for single room accommodation.

Health services are able to make their own determination on accommodation fees to be charged to private patients who receive treatment at their campuses (NOTE: This also applies to sameday patients).  In coming to this decision, health services should consider the following:

  • the benefit that private health insurance funds will assign to the public hospital in their health insurance products
  • any copayment a patient may be willing to pay as a private patient
  • the amount of any copayment or excess the hospital can viably forego.

To assist health services with this decision, the department provides a guide of average costs and nominal cost recovery rates for private patient accommodation in the Fees Manual. 

For patients who elect to be treated as private patients, hospitals will make all reasonable endeavours to:

  • encourage patients to contact their doctor and health fund to discuss the financial implications of an upcoming episode of hospitalisation any copayment a patient may be willing to pay as a private patient
  • make provision in hospital admission papers (for public hospitals: in the    standard in-patient election form) for patients to sign an acknowledgement that they have given Informed Financial Consent.
  • except where the admission is an emergency, ensure hospital admission procedures, information systems and admission forms facilitate the effective operation of the process, including an Informed Financial Consent proforma with other admission papers for patients to sign (if one has not been signed prior to admission).

The Private Health Insurance (Health Insurance Business) Rules 2007 Part 3 Section 8(b) state that treatment provided to a person in an emergency department of a hospital is excluded treatment for the purposes of Private Health Insurance.  Health Services should ensure that private health funds are not billed for services provided to private patients within the emergency department.

The department’s guide for private patient fees for 2015-16 are outlined below.

Shared Ward Accommodation

For 2015-16, the department has continued to align its recommended shared room fees with the Commonwealth's default minimum benefits to ensure that private patients do not incur gap payments or out of pocket expenses.  Health services should note recent analysis by the department which shows that the actual cost of providing accommodation to private patients is significantly higher than the Commonwealth’s minimum benefits.

Patient Classification
Length of Stay

Commonwealth minimum benefit for shared ward accommodation 2015-16

Average actual cost per bed day 2015-16
(i)

Advanced surgical patient:
• first 14 days
• over 14 days

 

$410
$285

 

$810
$808

Surgical or obstetric patient:
• first 14 days
• over 14 days

 

$381
$285

 

$786
$666

Psychiatric* patient:
• first 42 days
• 43-65 days
• over 65 days

 

$381
$330
$285

 

$916
$829
$725

Rehabilitation* patient:
• first 49 days
• 50-65 days
• over 65 days

 

$381
$330
$285

 

$546
$531
$591

Other patient:
• first 14 days
• over 14 days

 

$330
$285

 

$754
$681

(i) Based on the 2013-14 Victorian Cost Data Collection using IPHA indexation rates for the ensuing years to 2015-16. Includes capital and depreciation loading.

* The circumstances under which Rehabilitation and Psychiatric fees can be charged by hospitals were clarified under changes to the Private Health Insurance (Benefit Requirements) Rules 2011. Payment for patients undergoing psychiatric or rehabilitation treatment, is subject to health insurer approval of a particular treatment program and the relevance to the patient diagnosis. Refer circular PHI 78/11.

Single Room Accommodation

Patient Classification
Length of Stay

Nominal cost recovery rate (ii) 2015-16

Advanced surgical patient:
• first 14 days
• over 14 days

 

$875
$815

Surgical or obstetric patient:
• first 14 days
• over 14 days

 

$960
$864

Psychiatric* patient:
• first 42 days
• 43-65 days
• over 65 days

 

$996
$909
$805

Rehabilitation* patient:
• first 49 days
• 50-65 days
• over 65 days

 

$626
$611
$671

Other patient:
• first 14 days
• over 14 days

 

$806
$769

(ii) Based on the 2013-14 Victorian Cost Data Collection using IPHA indexation rates for the ensuing years to 2015-16. Includes capital and depreciation loading.

* The circumstances under which Rehabilitation and Psychiatric fees can be charged by hospitals were clarified under changes to the Private Health Insurance (Benefit Requirements) Rules 2011. Payment for patients undergoing psychiatric or rehabilitation treatment, is subject to health insurer approval of a particular treatment program and the relevance to the patient diagnosis. Refer circular PHI 78/11.

Note: Where a patient is placed into a single room and they have elected to have a single room they are to be charged the single room rate. Hospitals should not retrospectively seek a single room election from a patient after a private patient is placed into a single room for clinical need.

Patient Classifications

The classifications advanced surgical, surgical and other are defined in Schedule 1 of the Private Health Insurance (Benefit Requirements) Rules 2011, made under the Private Health Insurance Act 2007. The item numbers contained in each classification are taken from the Medicare Benefits Schedule (MBS) and based on the complexity and fee charged for the procedure.

The determinations contain schedules of MBS item numbers for professional services under each patient classification. Schedule 1 specifies:

advanced surgical patient: is specified in Part 2 of this Schedule and the item numbers are derived from the MBS.

surgical patient: is specified in Part 2 of this Schedule and the item numbers are derived from the MBS.

obstetric patient: is specified in Part one of this Schedule. (definition taken from Part 2 of Schedule 1)

psychiatric patient: is a patient in a hospital who is admitted for the purposes of undertaking a specific psychiatric treatment program that is deemed by the insurer to be relevant and appropriate for the treatment of the patient's disease, injury or condition.(definition taken from Part 2 of Schedule 1)

rehabilitation patient: is a patient in a hospital who is admitted for the purposes of undertaking a specific rehabilitation treatment program that is deemed by the insurer to be relevant and appropriate for the treatment of the patient's disease, injury or condition.(definition taken from Part 2 of Schedule 1)

other patient: are deemed to be any patients in a hospital other than advanced surgical, surgical, obstetric, psychiatric, or rehabilitation patients.(definition taken from Part 2 of Schedule 1)

Reference: Private Health Insurance (Benefit Requirements) Rules 2011 http://www.comlaw.gov.au/Details/F2013C00094

For Commonwealth's advice on the correct benefit level in regard to pre-operative day arrangements, see HBF605

IF YOU REQUIRE FURTHER INFORMATION

PLEASE TELEPHONE:(02) 6289 9853 - 24 HOUR ANSWERING SERVICE - Private Health Industry Branch, Commonwealth Department of Health or email the enquiry to PrivateHealth@health.gov.au

3.2 Same Day Patients

The following fees are charged for all same day patients who, on admission to a public hospital, have elected to be treated as private patients. Same day patients admitted for minor procedures (that is, those procedures contained in the Commonwealth's Type C exclusion list) must be certified as requiring hospital admission.

Band

Commonwealth
minimum
benefit for
shared ward
accommodation
2015-16

Nominal cost recovery rate 2015-16**

Same day Band 1

$241
$330

Same day Band 2

$285
$393

Same day Band 3

$331
$454

Same day Band 4

$381
$523

** does not include a capital and depreciation loading.

(See section on Compensable Patients for compensable same day patients).

Same Day admissions are generally governed by Commonwealth legislation. Decisions on whether to admit or not admit patients as same-day cases revolve around explicit inclusions and exclusions for procedures/conditions set by the Commonwealth.
Comprehensive lists covering procedures considered to be Type B and Type C are maintained, and are referred to as the:

  1. Admitted procedures (Type B) list
  2. Non-admitted procedures (Type C) list.

These lists can be found in Appendix 2 - 1. Admitted procedures (Type B) list and Appendix 3 - 2. Non-admitted procedures (Type C) list. These are based on Schedule 3 of the Private Health Insurance (Benefit Requirements) Rules

FOR ENQUIRIES/INFORMATION on the ‘Type B’ and Type C’ procedure lists; Day Only Procedures Manual, and Internet site address, you can contact the Private Health Industry Branch, Commonwealth Department of Health and Aged Care via their 24 hour answering machine service (02) 6289 9853 or Email the enquiry to PrivateHealth@health.gov.au.

Website: www.health.gov.au/internet/wcms/Publishing.nsf/Content/health-privatehealth-providers-circulars.htm

Next Page >>

Last updated: 17 March, 2016

For information relating to this site, contact: Peter Lewis Ph: (03) 9096 9050

This website is managed and authorised by the Finance, Policy and Operations Unit, Chief Finance Officer Branch of the Finance and Corporate Services Division of the Department of Health, Victorian State Government, Australia

Copyright | Disclaimer | Privacy Statement | State Government of Victoria Home | Download Help

For general enquiries to the Department of Health and Human services telephone 61 3 90960000