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Fees and Charges for Acute Health Services in Victoria
 
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Section A: Admitted Patients
Section B: Non-Admitted Patients
Section C: Other Services
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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

Patient Classification Rates for 2014‑15
Accommodation charges – fee per day
Same day  
  • single room
$641
  • shared ward
$283
Overnight (multi day)  
  • single room
$871
  • shared ward
$782
Intensive Care Unit (ICU)  
  • 1 - 4 days
$4,139
  • 5 + days
$3,167
Coronary Care Unit (CCU)  
  • 1 - 4 days
$1,454
  • 5 + days
$1,165
Special Care Nursery $861
Emergency Department $458
Hospital in the Home $234
Outpatients – fee per encounter
  • Medical
$293
  • Allied Health
$212
Postnatal care – hourly rate* $89.10 per hour

The following items will be separately charged to the fee determined on either a DRG or bed day basis:
(i) Theatre fees charged based on TAC Schedule of Fees for Private Hospital Services (Non Arrangement).
http://www.tac.vic.gov.au/upload/Hospital.Private.Non-Arrangement.pdf
(ii) Prostheses in line with the Commonwealth’s schedule rate.
(iii) Diagnostics at 100% of CMBS.
(iv) Drugs at cost (Note: only for bed day fee as DRG fee already includes drug costs).
Note: Medical costs are billed separately by the treating medical practitioner and are not included in the above.

* 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:

  • the Department's PRS/2 Manual (as may be amended from time to time), which can be accessed though:Internet website: www.health.vic.gov.au/hdss/vaed/ and refer: Part A, Definitions Related to Patients (- see also specification changes at www.health.vic.gov.au/hdss/vaed/ )
    • Patient Categories
      • Eligible Person
        • Australian Resident
        • Eligible Overseas Representative
        • Reciprocal Health Care Agreements
        • Persons Declared Eligible by the Minister
      • Ineligible Person
      • Types of Ineligible Patient
        • Exempt Patient
        • Non-Exempt Patient.

Reciprocal Health Care Agreements (RHCA)

Circular No. 23/2009 Reciprocal Health Care Agreements

Asylum seekers

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.

www.immi.gov.au/media/fact-sheets/62assistance.htm

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:

Standard Fees

Benefit (private patients) $118.00
Patient Contribution (public & private patients) $54.75

(See section on Compensable Patients re: compensable nursing home patients)

Date of effect: 20 September 2013
Reference: Circular No. 11/2013

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: 19 September, 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

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