How Does Private Healthcare Work?

Private healthcare offers you a more premium healthcare experience. But how do you gain access to private healthcare, and how does it work?

In this guide, we’ve put together some essential information to help you make the most of your private healthcare experience, and to ensure you’re getting the high-quality private healthcare you’re entitled to.

How to access private healthcare

The process of accessing private healthcare is not dissimilar to accessing public healthcare. The only difference is that you will need to be ready to pay the cost of your own treatment (or organise for your insurer to pay for it).

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Self-paid vs health insurance – which should you choose?

When it comes to accessing private healthcare, it’s important to remember that you will need to cover the costs of any treatment you receive. There are two ways to pay for private healthcare, either:

from your own pocket, or
through a private health insurance policy

The route you choose will depend on the type of treatments you might want to receive, the cost of healthcare in your country and your own budget.

Going self-paid

If you are confident that you can afford the cost of your own private healthcare, you may prefer to pay from your own pocket. This may be the most suitable option if:

You live in a country where the cost of private healthcare is more affordable
You have ample funds ready to spend on healthcare
You don’t want to commit to a yearly premium for health insurance you may never use, and would prefer to save your own money to cover your healthcare costs
You have pre-existing medical conditions that won’t be covered by health insurance

If you choose to go self-paid, it’s important to remember that the costs of private healthcare can quickly escalate, especially if you are diagnosed with a major illness, or experience a serious injury.

For instance, while you may be able to easily afford the cost of a GP consultation, could you also afford a full course of cancer treatment, which could last several months or even years?

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Private health insurance

Your alternative is to take out private health insurance. With private health insurance, your health insurer will pay the bill for any private medical treatment you receive, so long as your insurance policy covers that form of treatment. Private health insurance may be right for you if:

You live in a country where private healthcare is expensive
You are worried that you could not afford the cost of major medical treatments out of your own pocket
You want comprehensive cover against any number of potential medical conditions
You receive private medical insurance benefits through your company

With private health insurance, you will need to pay an annual premium for your insurance. The cost of this premium is calculated by the ‘risk’ you represent to the insurer (i.e. the company that pays your claims).

Your premiums may be higher if you are older, in poor health, have a history of medical conditions, or if you live in a country where the cost of private medical treatment is high (such as Hong Kong).

Remember, some private health insurance providers may be unable to provide cover if you live in certain countries, or if you have pre-existing medical conditions.

Choosing the right private health insurance policy

Your insurance policy may cover you for access to one specific hospital or healthcare group (e.g. if you are insured with BUPA in the UK, you will only be entitled to care at BUPA hospitals).

Or, you may have access to any private hospital or clinic within a wider network, sometimes localised to one country or region. This may also include access to public healthcare facilities in countries where foreigners cannot use public healthcare.

As an expat, you may be interested in international private health insurance. With this, you can enjoy worldwide cover, meaning you can walk into almost any hospital in the world and expect to be treated.

With William Russell’s international health insurance policy, you’ll be entitled to private healthcare at any hospital in your chosen coverage zone. So, if you live in Australia with Zone 1 cover, you’ll still be able to walk into any public or private hospital and receive care whether you’re in Germany, Canada, Argentina or elsewhere!

This means no matter where you go, you’ll be covered for emergency treatment, routine procedures, health check-ups, medical evacuations and visits to the pharmacy, plus all the optional services you’ve added to your policy such as maternity care, mental health services and dentistry.

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What is the experience of private healthcare like?

In a nutshell, private healthcare may give you access to:

A more comprehensive range of treatments
Higher-quality medical technology and healthcare professionals
More comfortable hospital accommodation
Improved outcomes

As a private healthcare patient, you can expect a more premium healthcare experience at every touchpoint.

However, private healthcare also tends to come with an extremely high price tag. Still, many private healthcare customers agree that it is worth the extra cost, as there are many advantages to choosing private healthcare. Some of these include:

Shorter waiting lists

Whether you are visiting the doctor for a check-up, or undergoing surgery in a hospital, you can expect to be seen and treated much faster in the private healthcare sector.

For example, in Germany, the average waiting time to see a doctor in the public healthcare system is 4 days, while in the private sector it is 3 days. In the UK, the median waiting time for elective care for NHS patients is a staggering 14.5 weeks, and 4 out of 10 patients who opt for private healthcare in Britain say that they do because of NHS waiting times.

Personalised care

Personalised care is an advanced form of healthcare practice that allows specialists to treat patients based on their individual needs. This can include taking a snapshot of the patient’s genetic profile to find medications and treatments that match their profile. This can often lead to improved patient outcomes, perhaps with fewer side effects and a shorter recovery period.

With personalised care, patients also get to have a say in the type of treatment they receive, giving them more confidence. Personalised healthcare is a rapidly growing market – the number of personalised medications available in the USA more than doubled between 2016–2020.

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Modern facilities

Because funding comes from the private sector, private hospitals and clinics are not constrained by government budgets. They are therefore free to design and upgrade their facilities to meet their patient’s expectations. This means they can invest in the latest medical technologies, provide more comfortable accommodation and employ the latest information technology products to enhance the patient experience.

A recent study in India found that patient satisfaction is significantly higher in private sector hospitals: while 71% of public hospital patients rated the quality of their experience as low, 60% of private sector patients said it was high.

Improved patient outcomes

Because private hospitals have access to better human and technological resources, they are better able to treat patients with the latest procedures and medications. As a result, some studies have shown that patients in private hospitals tend to experience better outcomes than those in public hospitals.

Perhaps most importantly, patient mortality is far lower in private hospitals. One study in Chile found patient mortality to be as low as 0.7% in private hospitals, compared to 3.5% in public hospitals.

Suffice to say, the exact benefits of private healthcare will depend on the hospital and the provider you choose, as well as the type of treatment you are after.

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Where are the best private hospitals?

Because its healthcare system is almost entirely privatised, the United States dominates the global leaderboards for the best private hospitals. This is reflected in the price of health insurance in the US, which is among the highest in the world.

Outside the US, the quality of private hospitals can vary according to region. In some countries, the best hospitals may even be those run by the public healthcare system. As an expat living abroad, be sure to do your research in order to find the right hospital to suit your needs.

According to Insider Monkey, the 10 best private hospitals in Europe in 2024 are:

Hirslanden Klinik Im Park

Zurich, Switzerland

Wiener Privatklinik

Vienna, Austria

Lister Hospital

London, UK

Centre Hospitalier Universitaire Vaudois (CHUV)

Lausanne, Switzerland

Heiligenfeld Kliniken

Berlin, Germany

Hospital Da Luz

Lisbon, Portugal

Hospital De La Tour

Geneva, Switzerland

IRCCS Policlinico San Donato

Milan, Italy

Fundacion Institut Guttmann

Barcelona, Spain

Das Rehaportal

Online (Germany)

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Accessing private healthcare: step-by-step

If you’re accessing private healthcare for the first time, you may find the process to be slightly different to accessing public healthcare. It’s important to remember that, as a paying customer, you have much more control over your choice of treatments and doctors. Here’s what the process may look like for a private healthcare patient:

1/ Know your health insurance policy

If you are accessing private healthcare through your health insurance, the first and most important step is to understand the remit and limitations of your policy.

Your policy may outline which hospitals and clinics you are entitled to receive treatment at, the kind of services you are covered for, the countries included within your coverage zone, and the maximum price (or coverage limit) you are allowed to claim for.

Check your coverage

Be sure to check the standard terms of your policy. Does it cover the treatments you need?

You should also check the certificate of insurance issued by your insurer. Are there any special terms that might affect your eligibility to receive certain types of treatment?

Your policy may contain unique wording relating to your individual health, particularly if you have undergone a medical examination during your underwriting process and are known to have pre-existing medical conditions. Certain conditions may be restricted. If you present at a hospital with a restricted condition, you may not be able to later make a claim.

You may also be limited to certain hospitals and clinics (for instance, if you hold a policy with a particular healthcare brand). If this is the case, you will need to know where your nearest hospital is, and the kind of healthcare services it offers.

Remember, your nearest private hospital may not offer emergency healthcare services, so if you do experience an emergency you may need to visit the accident room at your nearest public hospital instead.

If you’re paying from your own pocket

You can also choose to pay the cost of your healthcare out of your own pocket.

Beware, this can be extremely expensive depending on the type of treatment you need (although some healthcare providers will offer a discount to self-paying customers).

The process of accessing healthcare will be more-or-less the same if you are self-paying, however you won’t be able to use the additional services private health insurance members have, such as the insurance company’s helplines and customer services.

Hospitals may also sometimes charge you less when you’re paying from your own pocket, compared to if the insurer is picking up the bill.

When it comes to paying for treatment, private healthcare providers may ask you to provide proof of funds at the point of referral, while others may ask for payment up-front.

2/ See your GP

Now it’s time to seek treatment. Your first port of call should be a primary care doctor who can either solve the problem themselves, or refer you to a specialist.

You have several options when it comes to choosing a doctor. Your private health insurance policy may include access to a private family doctor (GP), either in your local area or via teleconferencing. Many countries also offer you access to a doctor free of charge through the public healthcare system, while in other countries the cost of a doctor’s appointment is low enough not to impact your finances.

You may also wish to choose a private doctor of your own. Private doctors may offer services that other doctors in your area do not, such as same-day appointments and house calls.

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Can I skip seeing a doctor?

As a private healthcare patient, you may be able to self-refer. This is when you put yourself forward for a treatment, procedure or diagnostic process, whether or not you have been referred by a doctor.

So long as you are willing and able to pay for the treatment, and so long as a doctor agrees to treat you, you can undergo any number of elective procedures and treatments.

Many patients self-refer for treatments such as:

Mental health support
Physiotherapy and injury rehabilitation
Sexual health services
Maternity care
Podiatry
Hearing tests and eyesight tests

Remember that self-referrals are not always covered by your insurance, but your insurer may allow you to self-refer for certain types of treatment, such as counselling or physiotherapy. Some insurers even have a self-referral pathway for certain types of treatment.

Should I self-refer?

Self-referral is common for minor procedures, and can save the time it would normally take for you to be seen, and referred by a doctor.

However, it may also reduce the effectiveness of the outcome—for instance, if you self-refer without going through a proper diagnostic process, you may end up seeking the wrong form of treatment.

3/ Attend a specialist consultation

If your GP has decided you need to undergo further examination, your next step will be to attend a consultation with a specialist.

Depending on your case, your specialist may administer various tests and scans. This could involve travelling to other medical facilities and clinics in your local area. You may, for instance, need to undergo an x-ray, blood test, MRI scan, CT scan, echocardiogram or diagnostic work.

It’s a good idea to contact your health insurer before you go for these tests, as you may need to pre-authorise payment.

When it comes time to pay, some healthcare providers will ask for payment on the day, while others will roll the cost into your overall treatment plan.

If you need to pay separately, you should submit a claim to your health insurer. Be sure to inform your healthcare provider that you have insurance, and who your policy is with – they may be able to make the claim on your behalf, saving you some of the admin.

Understanding your excess

Your health insurance policy will include an excess or ‘deductible’.

This is the amount of money you will need to pay out of your own pocket before you will be able to make a claim.

If the cost of your healthcare does not exceed your excess, you will not be able to make a claim.

Learn more about excesses

4/ Get your results

Your specialist will write back to your GP with the results from your tests. Your GP will discuss these results with you, and make recommendations for the next stage of your treatment. You may be given options at this point as to how you would like to proceed.

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5/ Receive treatment

You will now be referred for treatment. This usually begins with a discussion with your specialist. They should provide you with both a price list and an outline of the services you can expect.

This should include additional costs, such as medications you will receive, nursing, and the price of an overnight stay in a private hospital. You should cross-reference everything in this outline against your health insurance policy to make sure you are covered for all stages of the treatment plan, and that it does not exceed your coverage limit.

Some healthcare providers will require you to pay the cost of your treatment up-front, while others will invoice you after your treatment. Either way, if you are a private health insurance customer, you only need to file a claim with your health insurance provider.

Alternatively, the hospital will bill the insurer directly. You should not need to put money down at the point of care, although some healthcare providers will ask you to pay your excess while you are in the hospital.

What if I miss an appointment?

If you miss an appointment and you don’t have a valid excuse, your healthcare provider may charge you a missed appointment fee. This is usually a nominal fee less than the value of the procedure, but in some cases they may charge you the full amount.

If you have private health insurance, your provider will usually stipulate in your policy wording that they cannot cover missed appointment fees, meaning you will need to pay these fines out of your own pocket. Be mindful of this, and try to attend all of your scheduled appointments.

6/ What’s next?

Your treatment plan may require you to attend follow-up appointments or to take medications. This can be for several weeks, years, or perhaps even for the rest of your life.

As a private healthcare patient, you are free to choose your own course of treatment, and the clinic you would prefer to attend. However, you must also be prepared to pay your own expenses.

If you have private health insurance and you require post-treatment care and medication, rehabilitation, or if you are undergoing an extensive treatment plan, you should enjoy full cover for these treatments.

Some healthcare providers will wait until you have finished your treatment before sending you a final invoice, while others will ask you to pay on an as-you-go basis. If you are paying through health insurance, you should contact your provider to let them know – they may be able to assist you with billing.

What if my condition returns in the future?

If you have been given the all-clear by your doctor, you should consider your treatment wrapped up and go through the billing and claims process as normal.

If the same condition returns within a few months, your health insurance provider may treat this as an extension of the same claim you made before.

However, if the illness returns after a few years, your insurer may treat it as a separate illness, and you will need to go through the claims process once again.

Long-term medication

After you have been discharged from hospital, your treatment plan may include medications that you need to take for an extended period, or even for the rest of your life.

Once you know your prescription, you should contact your health insurance provider. You may be able to claim against the cost of these drugs moving forward, especially if the drugs are expensive. However, if the cost of your medication is lower than your chosen excess, you may not be able to claim and you will need to pay for your medication yourself.

It’s worth visiting your nearest pharmacy to understand the cost of your medication, as this will help your health insurer decide whether or not you can make a claim.

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What if I need an ambulance?

In many countries, ambulances are provided free of charge. If you are in an emergency and need the support of paramedics or transport to your nearest hospital, do not hesitate to call the emergency services and ask for an ambulance.

Calling an ambulance

If you are living, working or travelling abroad, it’s important to know the number for the emergency services in your country. Be sure to familiarise yourself with this number in case you need it.

If in doubt:

112 is the emergency services number for over 100 countries, including all countries in Europe and many in Asia and Africa
911 is the emergency services number for many countries in the Americas, as well as some countries in Oceania and the Middle East
999 is the emergency services number for the UK and Ireland, and some countries in Africa
119 is the emergency services number in China, Taiwan, South Korea and Japan

In some countries, however, you will need to pay for an ambulance call-out. This price may include the cost of calling an ambulance, being treated by paramedics, any drugs or treatments administered, and transport to a hospital. The average cost for an ambulance call-out in the United States, for example, is US$1,309.

If you need to pay for an ambulance call-out, it will usually be added to your final bill once you have been discharged from the hospital. If you have private health insurance, your insurance provider should cover the cost of your ambulance transfer and any treatments you receive en-route.

What about medical evacuations?

A medical evacuation occurs when you need to be transported to another region or country for urgent medical treatment. This may happen in an emergency situation (for instance, you need to be rescued from a dangerous area), or it may come as part of your treatment schedule because of a lack of specialists or medical technology in the country you’re living in.

At William Russell, all our policies include emergency evacuation insurance as standard, so there’s no need to worry if you require long-distance transport.

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What about other forms of treatment?

Of course, you may not be seeking major treatment in a hospital. You may be looking for community healthcare services, outpatient care, ambulatory care, intermediate care or reablement, or any other type of general healthcare treatment.

Many of these procedures and treatment are not typically available from hospitals and public healthcare clinics, so you will often need to seek these services from the private sector.

Your health insurance policy may entitle you to these forms of healthcare, or you can choose to go self-funded. The types of healthcare you seek may include:

Dentistry
Physiotherapy
Sexual health services
Mental health services
Chiropractic treatment
Alternative medicine

Many of these forms of treatment will require you to self-present at a clinic. Your healthcare provider may ask for access to your medical records in order to treat you.

Does my insurance cover other forms of treatment?

Your health insurance policy may include access to non-hospital healthcare at private clinics. At William Russell, we offer several optional benefits with our health plans, such as:

Dental cover
Mental health treatment
Well-being services – including blood tests, cardiac risk testing, lung function tests, neurological examinations and eye examinations, plus vaccinations and cancer screening

When it comes to using these services, your policy wording should tell you how and when you can claim these benefits. This will usually be given in the form of an annual limit, meaning you will be entitled to claim the costs of these treatments from your health insurer after you have used them.

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International health insurance tailor-made for expats

At William Russell, we have over 30 years’ experience providing international health insurance to expats like you.

Our policies include everything you need to take care of your health, wherever you live. With hospital cover, outpatient treatment and even medical evacuation cover as standard, plus access to a network of over 40,000 hospitals worldwide, you can be sure you’ll have access to best quality medical care anywhere in the world.

Plus we offer a range of plans to suit your needs and budget, with optional extras including maternity cover, dental cover and mental health benefits.

Find out more about our international health insurance plans and get a quote online in under two minutes today.

Terms & conditions apply to our insurance products and services. You can find full details of what our plans cover (and what they don’t cover) in our plan agreements.

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