Paying for treatment in Australia: how each route pays
There are four ways treatment is paid for in Australia: as a public patient in a public hospital, through the Medicare benefit, through private hospital cover, and by paying the provider yourself. This section sets out what each route covers, the wait and the price for each treatment, using only what governments, regulators and providers publish. Each figure carries its source and the date it was read. Where a route publishes nothing, or this site has not read it, the page says so rather than estimating.
The four routes
Public hospital
No charge as a public patient in a public hospital. Treatment by a doctor the hospital appoints; you cannot choose your doctor, and you may be placed on a public hospital waiting list.
Waits for elective surgery are published by AIHW. Public hospitals only. Time from being added to the surgical waiting list to admission; excludes the wait to see a specialist. Each treatment page shows the national median and the state rows.
Source: privatehealth.gov.au: Medicare, read 26 October 2026.
Source: AIHW MyHospitals: elective surgery, 2024-25, read 26 October 2026.
Medicare benefit
Medicare pays a set benefit for each item on the Medicare Benefits Schedule (MBS), towards the doctor's fee. Doctors set their own fees, so the benefit is not the price. Outside hospital, Medicare pays a benefit towards a GP or specialist fee; if the doctor bulk bills, there is nothing to pay.
Treatment pages list the MBS items one by one and never add them together. Each item links to MBS Online; the fee and benefit are not reproduced here until the MBS reuse terms are confirmed.
Source: MBS Online, release 20261101, read 26 October 2026.
Private hospital cover
Described here as a mechanism only. TreatCompare does not name, compare, rank or price any insurer, policy or premium. Medicare does not cover private-patient hospital costs such as theatre fees and accommodation.
APRA reports that 84.6% of the 11,094,144 in-hospital medical services insurers paid for in the Jun 2026 quarter had no medical gap, all insurers combined. APRA counts a service as having no medical gap when it was billed under a no-gap agreement, or with no agreement at or below the MBS fee. Treatment pages show APRA's figures for the specialty group a procedure sits in.
Source: APRA quarterly private health insurance statistics: medical gap, Jun 2026, quarter to Jun 2026, read 26 October 2026.
Source: Australian Prudential Regulation Authority (APRA), Quarterly Private Health Insurance Statistics, licensed under CC BY 3.0 AU. APRA does not endorse TreatCompare or its use of the data.
Self-pay
Self-pay prices are read from hospitals' own pages. Coverage so far: 3 private hospitals' self-pay price pages read (Maryvale Private Hospital, Mulgrave Private Hospital, Northern Private Hospital). Its figures are "from" prices, each with what it includes. For a procedure that page does not list, treatment pages say the self-pay price is not tracked. No self-pay wait has been read anywhere.
Source: Maryvale Private Hospital: self-pay surgery, read 26 October 2026.
Treatments, A to Z
Each page sets the four routes side by side for one treatment.
- Cataract surgery
Lens extraction and intraocular lens insertion.
- Colonoscopy
Examination of the bowel with a flexible camera, with or without polyp removal.
- Gallbladder removal
Cholecystectomy, open or laparoscopic.
- Gastroscopy
Upper gastrointestinal endoscopy, with or without biopsy.
- Hip replacement
Total hip replacement.
- Hysterectomy
Abdominal, vaginal or laparoscopic hysterectomy.
- Inguinal hernia repair
Repair of an inguinal hernia, open or laparoscopic.
- IVF
A stimulated IVF treatment cycle and the procedures billed with it.
- Knee replacement
Total knee replacement.
- Tonsillectomy
Removal of the tonsils, with or without the adenoids.
What is held back, and why
- MBS fees and benefits: read from the MBS Online data file and stored, not reproduced until the reuse terms are confirmed. Pages link each item to MBS Online.
- Out-of-pocket costs for insured patients by procedure: the Australian Government's Medical Costs Finder publishes these, but its reuse terms have not been confirmed, so none are shown.
- Private hospital and self-pay waits: none is published, so none is shown.
Sources
- privatehealth.gov.au: Medicare. Read 26 October 2026. What Medicare covers for public patients, and what it does not cover.
- MBS Online, release 20261101. Read 26 October 2026. Medicare Benefits Schedule items and benefits, per item.
- AIHW MyHospitals: elective surgery, 2024-25. Read 26 October 2026. Based on Australian Institute of Health and Welfare material, licensed under CC BY 4.0. TreatCompare is independent of AIHW, and AIHW does not endorse this site. Public hospitals only. Time from being added to the surgical waiting list to admission; excludes the wait to see a specialist.
- APRA quarterly private health insurance statistics: medical gap, Jun 2026, quarter to Jun 2026. Read 26 October 2026. Source: Australian Prudential Regulation Authority (APRA), Quarterly Private Health Insurance Statistics, licensed under CC BY 3.0 AU. APRA does not endorse TreatCompare or its use of the data.
- Maryvale Private Hospital: self-pay surgery. Read 26 October 2026. 3 private hospitals' self-pay price pages read (Maryvale Private Hospital, Mulgrave Private Hospital, Northern Private Hospital)