Department of Health

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 Group (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

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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