• Medical Orientation

Private and Compensible Patients

Why is it important?

The Government expects that the hospital will draw in a certain amount of funding from admitting private and compensible patients (privately insured, TAC, Workcover and DVA) on the basis of demographic data (such as the percentage of patients in a community with private health insurance) and they fund the hospital accordingly.

As such, failure to capture such patients (i.e. admitting them publicly) means a significant loss of revenue for the hosptial which means a significant drop in the services that can be provided.

What can I do?

Every patient should have been asked by Health Information Staff on arrival whether they are privately insured, have a DVA card, or are here because of a workcover or TAC matter. Their BRADMA label should reflect this status. So the first thing you can do is look at the BRADMA and when you are discussing admission to hospital with the patient ask "Will you be using your private health insurance for this?"

But wait, you can do more! It turns out that the HIS staff are only human and may miss some cases. So it is best if you ask every patient "Do you have private insurance?"

What's in it for the patient and will it cost them anything?

There will be no out of pocket costs for patients admitted privately at Bendigo Health. Where a doctor charges a gap (which is rare) or where there is an excess on the policy the hospital will cover that cost.

The patient will get a choice of doctor although in some cases they will be taken care of by the on call specialist overnight and handed over to their preferred doctor the next day.

The patient will also get some comforts like a newspaper and free TV hire and an enhanced menu.

Most of all, the patient will be helping their local hospital which is good for their community. A lot of people will be pleased to do so, especially when they discover it won't cost them anything.

Please note that TAC patients who are discharged from ED without hospital admission will be responsible for their own excess which is $500. TAC patients admitted to SSOU or the hospital will not have this problem. To keep that in perspective, the ambulance bill alone will be $1400 so the excess will be reached in most cases before ED care even comes in to the equation.

Private patient admission flowchart

Click here for a flowchart that attempts to lay out the process for private patient admissions. There is some work to be done in this domain yet but the current state of play seems to be that private admissions to this hospital go through the unit registrar who will then contact the relevant consultant. The patient will usually be admitted under the consultant of the day (surgical specialties) or the AMU consultant (medical) and then passed on to the usual or patient preferred consultant at a mutually agreeable point which can be negotiated outside of ED. Cardiology patients are best admitted directly under the desired private cardiologist and O&G patients are currently not admitted privately to BHCG.