Hospital Circular 25/2004: Hospital Circulars - Department of Health, Victoria, Australia

Hospital Circular 25/2004

Date Issued: 25 September 2004

Distribution: Public Hospitals

Attention: Public Hospitals, Extended Care Centres, Metropolitan Health Services, and Regional Offices

Subject: Patient Election Procedures

Hospitals should note that all eligible persons have the choice to be treated as either public or private patients. Election to be treated as a public or private patient must be made by the patient or their legally authorised representative before, at the time of, or as soon as practicable after admission. The patient or their legally authorised representative should sign a statement acknowledging that they have been fully informed of the consequences of their election, that they understand these consequences and that they have not been directed by a hospital employee to a particular decision.

Where admitted patients or their legally authorised representatives do not make a valid or actual election, these patients will be treated as public patients and the hospital will choose the doctor until such time as a valid election can be made. When a valid election is made, that election can be considered to be for the whole episode of care commencing from admission.

After admission and initial election, patient election status can only be changed in the event of unforseen circumstances. Examples of unforseen circumstances include, but are not limited to:

Patients who are admitted for a particular procedure but are found to have complications requiring additional procedures;
Patients whose length of stay has been extended beyond those originally and reasonably planned by an appropriate health professional; and
Patients whose social circumstances change while in hospital (for example loss of job).

Inadequate private health insurance cover is not a sufficient reason for changing a patient’s election status.

In situations where a valid election is made, and then changed later because of unforseen circumstances, the change in patient status is effective from the date of change onwards and should not be retrospectively backdated to the date of admission.

Election forms

The admitted patient election form and information sheet included in the Fees and Charges Manual has been updated to reflect the requirements of the National Standards for Public Hospital Admitted Patient Election Processes (Schedule E of the Australian Health Care Agreement).

Hospitals can tailor election forms to meet individual hospital requirements. However, development of local election forms must be consistent with the National Standards and the Australian Health Care Agreement. The current practice of many Victorian hospitals, that do not use the information sheet from the Fees and Charges Manual but incorporate this information into other information provided to patients, is consistent with this approach.

All elections forms in use in Victorian public hospitals must comply with the National Standards. Hospitals are requested to review their election forms in light of the National Standards and make any required amendments. To assist you, the patient election form and the accompanying information sheet Victorian Public Hospitals-Information for Patients are provided as samples.

Multiple and Frequent admissions election forms

The Department is aware that some hospitals have developed election forms suitable to patients who require multiple or frequent admissions. This is appropriate provided that patients have the same information and choices as the single admission election form and the form is consistent with the National Standards and the Australian Health Care Agreement. Additionally, forms should be for a specified period, not exceeding six months, and nominate the hospital unit where the treatments will be provided.

The Fees and Charges Manual has been updated with this information.

Hospitals can obtain a copy of the form from the Australian Health Care Agreement website.

Shane Solomon
Executive Director
Metropolitan Health and Aged Care Services

Victorian Public Hospitals - Information for Patients

Victorian Public Hospitals - Information for Patients (pdf file, 54kb)

The Medicare Agreement between the Commonwealth and State governments requires that YOU (or your agent) elect to be treated as a public (non-chargeable) or private (chargeable) patient upon admission to this hospital. Hospital employees cannot direct you towards making a particular decision.

Your election status (public or private) is valid from the commencement of your admission (admission date) through to the end of the admission.

You (or your agent), having made an informed election to be treated as a public or private patient upon admission to this hospital, cannot change your initial election status except in the event of unforeseen circumstances.

Examples of unforeseen circumstances include, but are not limited to:

Patients who are admitted for a particular procedure but are found to have complications requiring additional procedures
Patients whose length of stay has been extended beyond those originally and reasonably planned by an appropriate health care professional
Patients whose social circumstances change while in hospital (for example loss of employment)

Inadequate private health insurance cover is not a sufficient reason for changing your election status.

In situations where a change is made to election status because of unforeseen circumstances, the change in patient status is effective from the date of the change onwards, and is not retrospectively backdated to the date of admission.

A Public Patient

Must be eligible to receive treatment under Medicare
Will be treated by doctors nominated by the hospital
Cannot chose a specific doctor to provide his/her medical treatment, and
Will not be charged for medical or hospital services.

You cannot choose to be a public patient if you:

Elect to be treated by a doctor of your own choice
Elect to occupy a bed in a single room, or
Are not eligible to receive treatment under Medicare.

Note that single rooms are not available in all Victorian public hospitals. Where present, these are allocated first to patients with specific medical or clinical need for single room accommodation. Private patients desiring a single room will be allocated this accommodation only if the single room is not medically required for other patients.

A Private Patient

Will be treated by his/her nominated doctor(s) provided that the doctor(s) has the right to practice at the hospital, and
Will be responsible for the payment of the hospital accommodation fees, charges for all medical and diagnostic services, prosthesis, dental fees and other related services.

Private Health Insurance

Does not stop you from electing to be a public patient
Will cover full cost of shared ward accommodation but may not fully cover costs (depending on level of cover) if single room accommodation is chosen
Medicare will cover 75% of the Commonwealth Medical Benefits Schedule fee for the medical services provided to private patients while in hospital and private health insurance will cover the remaining 25% of the fee
Where a doctor charges a fee which exceeds the Commonwealth Medical Benefits Schedule fee, the patient will be responsible for paying the difference between the fee charged by the doctor and the Schedule fee.

Your authorisation is required by the hospital to enable release of a copy of your admitted patient election form to your health insurance fund (if this is requested by the fund). Failure to give this authorisation may result in the refusal of the health fund to provide benefits.

Compensable Patients

If you are, or may be, entitled to, (or have already received) compensation, damages or other benefits in respect of the injury, illness or disease for which you are receiving hospital care and medical treatment, all fees and charges may be met by your compensation. This includes, for example, compensation under the Accident Compensation Act 1985 (Vic), Transport Accident Act 1986 (Vic), Criminal Injuries Compensation Act 1983 (Vic), Safety Rehabilitation and Compensation Act 1988 (Cth), or a claim for damages at common law.

Veterans' Affairs Patients

Veterans' Affairs patients are those for whom the Department of Veterans' Affairs has agreed to accept responsibility for hospital charges for the condition for which you are being admitted.

Form of Election for Admission to a Public Hospital

Form of election for admission to a public hospital (pdf file, 60kb)

I (name)....................................................................................................................

of (address)................................................................................................................

elect for myself / or on behalf of (patient name).............................................................................

I understand that:

All eligible persons have the right to choose to be treated as either public or private
A person with private health insurance can elect to be treated as a public patient
Provided I (or my agent) has made an independent informed decision, my initial election status cannot be changed except in unforeseen circumstances
This election is valid for the entire episode of care in this hospital, commencing on my admission date.

I have received a copy of Victorian Public Hospitals – Information for Patients (part 2 of this form).

Private (chargeable) Patient

Choosing option 1 or 2 or both will make me a private patient and I will be responsible for all charges listed below. I understand that my health insurance policy may not fully cover the costs incurred by treatment as a private patient. (a) Hospital accommodation fees (b) Charges for medical services, including diagnostic services performed and/or ordered by the doctor of my choice or by other medical practitioners to whom I may be referred (c) Prostheses (d) Dental and other related services. I authorize the hospital to release a copy of this admitted patient election form to my private health insurance fund.
Option 1. I elect to be treated by Dr
Option 2. I elect to be treated in a single room. Yes/No
Signed:
Relationship to patient (if applicable)			Date

Note that single rooms are not available in all Victorian public hospitals. Where present, these are allocated first to patients with specific medical or clinical need for single room accommodation. Private patients desiring single rooms will be allocated this accommodation only if available single rooms are not medically required for other patients.

Public (non-chargeable) Patient

Choosing this option will mean that I am not charged for the hospital, medical and diagnostic services, prosthetic, dental and most others services provided to me and that I will be treated by a doctor(s) nominated by the hospital.
Signed:
Relationship to patient (if applicable)		Date

Compensable/Veterans' Affairs Patients

I (name)

declare that in the event of the rejection of a claim for hospitalisation as a:

Transport Accident Commission	Criminal Injuries Compensation
Department of Veterans' Affairs	Common Law Damages
WorkCover	Other (please specify)____________________

patient, I elect to be classified as a:

Private patient

Public patient

I have read the Information for Patients and I understand the consequences of this election.

Signed:

Relationship to patient (if applicable)

Date

DECLARATION BY HOSPITAL EMPLOYEE AS WITNESS

I (print name)
have witnessed the above election.
Signature
Relationship to patient (if applicable)		Date