Department of Health

Accommodation fees for Medicare ineligible patients

Health services are required to set their own fees for patients who are not covered by Medicare, including overseas patients. Fees for ineligible patients should be set to achieve full cost recovery. When charging fees, hospitals should be aware that some overseas patients are entitled to financial assistance (for example, Reciprocal Health Care Agreements).

Fees will vary between hospitals and may be determined on a Diagnostic Related Group (DRG) or bed day basis. Fees raised on a DRG basis are calculated using the DRG cost weight which are published in the Victorian Health Policy and Funding Guidelines.

The following table provides a guide to median costs per day/per encounter for services provided to Medicare ineligible patients. This is a guideline only and fees charged to Medicare ineligible patients are to be determined by individual health services.

Patient classification

Estimated median costs for 2021-22

Estimated range for 2021-22 (the department expects that costs for 50% of patients will fall within this range)

Accommodation charge - fee per day

     

Same day - single room

$177

$69

$336

Same day - shared ward

$219

$116

$314

Overnight - single room

$684

$490

$964

Overnight - shared ward

$574

$458

$732

Intensive Care Unit - 1-4 days

$6,568

$5,059

$7,721

Intensive Care Unit - 5+ days

$7,122

$5,852

$7,869

Coronary Care Unit - 1-4 days

$1,562

$1,484

$1,756

Coronary Care Unit - 5+ days

$1,575

$1,531

$1,598

Special Care Nursery

$4,539

$4,357

$6,223

Emergency department

$659

$355

$1,130

Hospital in the home

$411

$144

$565

Outpatients - fee per encounter

     

Medical

$287

$288

$289

Allied health

$183

$122

$316

Postnatal care - hourly rate

$99

N/A

N/A


Notes:

Except where indicated, estimated median costs are based on costs for 2017-18 reported to the Victorian Cost Data Collection, and an allowance made for indexation, capital and depreciation to estimate bed day and encounter costs for 2021-22. Note that a number of costs are excluded, and health services should ensure that they also charge for the following items in addition to any fee determined on either a DRG or bed day basis:

  1. Medical costs billed separately by the treating medical practitioner.
  2. Diagnostic services provided by health practitioners who are employed by the public hospital should be charged at 100 per cent of the Medicare Benefits Schedule rate and those provided by health practitioners who are not employed by the public hospital may exceed the Medicare Benefits Schedule rate.
  3. Prostheses, in line with the Commonwealth’s schedule rate.
  4. Drugs, which should be charged at cost (only when a bed day fee applies – fees determined on a DRG basis already include costs for drugs).
  5. Theatre fees, with charges based on the TAC Schedule of Fees for Private Hospital Services (Non-Arrangement).

Exclusions

Health services are required to provide Medicare-ineligible asylum seekers with full medical care under the same arrangements that apply to all Victorian residents. Patients in this category are not to be billed, with the exception of some non-admitted services. Funding for these patients is provided by the department as part of normal public patient throughout. More information on the eligibility and treatment of asylum seekers can be accessed at Refugee and asylum seeker health and wellbeing.

Both inpatient and outpatient services related to treatment of tuberculosis (TB), including pathology, diagnostics and pharmaceuticals, should be provided free of charge to all people presenting to public hospitals and health services in Victoria, regardless of Medicare eligibility or residency status. Refer to Hospital circular 06/2014 for more information.

Prisoners are ineligible for Medicare, under Section 19 (2) of the Health Insurance Act 1973. From 1 July 2015, prisoners receiving admitted, emergency department or specialist clinic services in Victorian public hospitals are to be treated and funded as public patients. Health services should cease to bill the Department of Justice and Regulation via primary care providers for these services provided to prisoners.

For further details, refer to Hospital circular 04/15.

To help determine eligibility status, and level of financial assistance (if any), see:

Victorian Admitted Episodes Dataset


Reviewed 24 February 2016

Health.vic

Contact details

Street address: 50 Lonsdale Street, Melbourne, Victoria, 3000

Department of Health and Human Services GPO Box 4057, Melbourne, VIC 3000

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