Section A: Fees for Admitted Patients
8. Eligible (including Reciprocal Health Care) and Ineligible Patients
Hospitals may set fees for patients who are not covered by Medicare including overseas patients. Fees for ineligible patients should be set to achieve full cost recovery. In setting fees, hospitals should be aware that some overseas patients are entitled to financial assistance (eg because of reciprocal health care agreements).
The fees will vary between hospitals, and are determined on either a DRG or bed day basis.
Fees raised on a DRG basis are calculated using the DRG cost weight and the private WIES rate. These are published in the Victorian health policy and funding guidelines. The private WIES rate is published in Part 2 at 2.20: Price tables, and DRG cost weights are found in Part 2 at 2.21: Cost weight tables.
The following table provides a guide to fees raised on a per day/per encounter basis. Please note that this is a guideline only, and that fees charged to Medicare ineligible patients are at the discretion of individual health services.
Ineligible Patient Accommodation Charge
The following items will be separately charged to the fee determined on either a DRG or bed day basis:
* Fee for Postnatal Care is based on Community Health Nursing hourly rates.
To help determine eligibility status, and level (if any) of financial assistance, see:
Reciprocal Health Care Agreements (RHCA)Circular No. 23/2009 Reciprocal Health Care Agreements
For information from the Commonwealth Department
of Immigration and Multicultural and Indigenous Affairs in relation
to assistance for asylum seekers in Australia (including Medicare
eligibility), please see the web link below.
For State arrangements for public hospitals with respect to Asylum seekers refer Circular 27/2005
9. Nursing Home Type Patients
The following fees are charged daily for nursing home type patients in public hospitals:
Benefit (private patients) $122.60
Date of effect: 20 September 2014
10. Pharmaceutical Fees
Public hospitals in Victoria that are participating in the Australian Health Care Agreement-Pharmaceutical Reforms are permitted to raise fees for admitted patients upon discharge, non participating hospitals are not permitted to raise fees for admitted patients upon discharge.
Patient Contribution per Prescription Item
General patients - up to $36.10 for PBS listed items and up to cost price for non-PBS listed items.
Concessional Beneficiaries - up to $5.90 for PBS listed items and up to cost price for non-PBS listed items.
Brand and Therapeutic Group premiums may also be applied by participating hospitals.
Information regarding the Pharmaceutical Benefits Safety Net Scheme and Concessional Beneficiaries can be found in Section B: Fees for Non-Admitted Patients
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Last updated: 17 November, 2014
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