Hospital and health service costs for Medicare ineligible patients
Health services are required to set their own fees for patients who are not covered by Medicare, including overseas patients. Where possible, ineligible patients should be charged the full cost of their care.
When charging fees, hospitals should be aware that some overseas patients are entitled to financial assistance (for example because of Reciprocal Health Care Agreements).
Fees will vary between hospitals and may be determined on a Diagnostic Related (DRG) or bed day basis. Fees raised on a DRG basis may be calculated using the national weighted activity unit (NWAU) price weight.
The following tables provide a guide to average costs for ineligible patients when applying an accommodation charge fee per day, outpatient fee per encounter, and postnatal care as an hourly rate. Column one shows the patient classification type. Column two shows estimated average costs for the year span 2022 to 2023.
Note: This is a guideline only and fees charged to Medicare ineligible patients are to be determined by individual health services.
Accommodation charge: fee per day
| Patient classification type | Estimated average costs for 2022-23 |
|---|---|
| Same day: single room | $375 |
| Same day: shared ward | $262 |
| Overnight: single room | $845 |
| Overnight: shared ward | $728 |
| Intensive Care Unit: 1-4 days | $5,887 |
| Intensive Care Unit: 5+ days | $5,414 |
| Coronary Care Unit: 1-4 days | $2,208 |
| Coronary Care Unit: 5+ days | $1,292 |
| Emergency department: admitted | $1,431 |
| Emergency department: non-admitted | $551 |
| Hospital in the home | $391 |
Outpatient charge: fee per encounter
| Patient classification | Estimated average costs for 2022-23 |
|---|---|
| Medical | $331 |
| Allied health | $191 |
Postnatal care charge: hourly rate
| Patient classification | Estimated average costs for 2022-23 |
|---|---|
| Medical | $100 |
Further information:
The accommodation charges are based on the 2020-21 Victorian Cost Data Collection.
The non-admitted charges are based on prior year's charges.
The fee for postnatal care is based on community health nursing hourly rates, as average cost cannot be calculated with the available data.
These charges include an allowance for indexation and depreciation to estimate bed day and encounter costs for 2022-23.
A number of costs are excluded. Health services should ensure that they also charge for the following items:
- Medical costs billed separately by the treating medical practitioner
- Diagnostics, which should be charged at 100 per cent of the Medicare Benefits Schedule rate
- Prostheses, in line with the Commonwealth’s schedule rate
- Drugs, charged at full cost when a bed day fee applies. If a DRG situation applies, the costs of drugs are already included
- Theatre fees. These are based on the TAC Schedule of Fees for Private Hospital Services (non-arrangement).
Reviewed 31 May 2022