Back to BlogFinance
Australian Hospital Private Patient Services 2026 — Election, Billing & Experience Guide
Complete guide to Australian hospital private patient services — private patient election in public hospitals, private billing, Access Gap Cover (AGC), private health insurance coordination, and private patient software.
Private patient election generates 20-30% more revenue for public hospitals. AGC eliminates patient gap payments. ~40% of Australians have private health insurance. This guide covers Australian private patient services.
Private Patient Election Process
- Eligibility check: Check patient has private health insurance with hospital cover
- Information: Inform patient of private patient option and benefits
- Election form: Patient signs private patient election form
- Health fund verification: Verify health fund details and coverage
- Pre-auth: Obtain pre-authorisation for procedures if required
- Doctor allocation: Allocate private doctor (where available)
- Billing: Bill health fund for hospital services, Medicare + fund for medical services
- Gap management: Manage gap via AGC or patient billing
- Follow-up: Post-discharge follow-up and satisfaction survey
Private Patient Revenue
| Revenue Source | Public Patient | Private Patient (Elected) |
|---|---|---|
| Hospital accommodation | State funding (casemix) | Health fund (per diem or DRG) |
| Medical services | MBS (100%) | Medicare (75%) + Fund (25%) + Gap |
| Prostheses | State funding | Health fund (prostheses list) |
| Theatre fees | State funding | Health fund |
| Allied health | State funding | Health fund (varies) |
| Total revenue per case | Baseline | +20-30% |
Private Patient Experience
- Private room: Private room where available
- Choice of doctor: Patient chooses their doctor (where available)
- Priority scheduling: Priority for elective surgery scheduling
- Dedicated coordinator: Private patient coordinator for admissions and billing
- Streamlined billing: Streamlined billing with health fund (no patient paperwork)
- Post-discharge follow-up: Post-discharge follow-up call
- Satisfaction survey: Private patient satisfaction survey
Frequently Asked Questions
- What is private patient election in Australian public hospitals?
- Private patient election is when a public hospital patient chooses to be treated as a private patient. Benefits: 1) Choice of doctor (where available), 2. Private room (if available), 3. Doctor bills Medicare (75%) + health fund (25%), 4. Hospital receives additional revenue from health fund. Some public hospitals actively encourage private patient elections (generates 20-30% more revenue than public patient).
- What is Access Gap Cover (AGC)?
- Access Gap Cover (AGC) is a scheme by Australian private health insurers to eliminate or reduce patient gap payments. Doctors who participate in AGC agree to the insurer's fee schedule. Benefits: 1) No gap or known capped gap for patient, 2. Doctor gets paid faster, 3. No out-of-pocket for patient. ~85% of specialists participate in AGC. Hospitals should encourage AGC participation.
- How does private health insurance work in Australian hospitals?
- Australian private health insurance: 1) Hospital cover — covers hospital accommodation, theatre fees, prostheses, 2. Medical cover — Medicare pays 75% of MBS fee, health fund pays 25%, 3. Gap — patient pays gap (or AGC covers it), 4. Excess — patient may pay excess (e.g., $500 per admission), 5. Pre-existing conditions — 12-month waiting period for pre-existing conditions, 6. Lifetime Health Cover — loading for late joiners.