Private Hospitals

Section 99 of the Accident Compensation Act 1985 (the Act) requires that when a worker has an injury which entitles them to compensation, WorkSafe, self insurer or employer is liable to pay the reasonable cost of the private hospital services required because of the workplace injury.   The WorkSafe fee policy for private hospitals is set within the context of the federal regulatory framework governing the private hospital industry.

The Department of Health and Ageing (DoHA) has set up a comprehensive framework of regulations under the National Health Act 1953 and the Health Insurance Act 1985, with the objective of providing affordable access to high quality private hospital and health care services to stakeholders who use and pay for these services.

This regulatory framework for private hospitals is widely accepted by private health industry stakeholders and is therefore a significant consideration for the WorkSafe in setting private hospital policy, guidelines and fees at reasonable cost.

The WorkSafe bases its private hospital reimbursement framework (including policy, guidelines and fee schedules) on those that are in place under the National Health Act 1953 and the Health Insurance Act 1985.  The basic structure of WorkSafe's compensable funding arrangements have been broadly developed within the service and fee frameworks issued by the Acute Care Division, Private Health Insurance Branch, Federal Department of Health and Ageing (DHoA) for privately insured patients. The WorkSafe's funding arrangements include accommodation classifications, theatre bands and prostheses implant lists. The WorkSafe reimbursement rates for private hospitals are set out in fee schedules that have been determined by WorkSafe to be both reasonable and the maximum amount applicable for services provided to injured workers as compensation by WorkSafe.

The DHoA private hospital regulatory and funding framework is used by WorkSafe as a guide for the development of private hospital policies and fee determination. It also provides the WorkSafe with surety of access, cost and the standard of hospital care provided to injured workers and funded as compensation.

• Private Hospital Invoicing Guidelines
• Prosthesis Guidelines for Private Hospitals
• Non Arrangement Private Hospital Fee Schedule effective 1 July 2009
• Non Arrangement Private Day Hospital Fee Schedule effective 1 July 2009
• Non Arrangement Private Rehabilitation Hospital Fee Schedule effective 1 July 2009
• Non Arrangement Private Psychiatric Hospital Fee Schedule effective 1 July 2009