Waiting Times for Elective Surgery in Australia - Public Vs Private System

General Medical

Surgeons perform an elective surgery on a patient that has been on the elective surgery waitlist for a long time.

Surgery wait times are a constant topic of discussion in Australia. Elective surgery waitlists have been around for decades. Even before the pandemic in 2020, the number of people receiving elective surgery in public hospitals was not keeping up with the demand for elective surgery. But the suspension of surgeries during parts of the pandemic has made the problem even worse.  

Difference Between Elective and Emergency Surgery

Elective surgery is any surgery that can wait more than 24 hours, and therefore, is not emergency surgery. It’s surgery that won’t be life-threatening if the patient waits. Elective surgery is usually performed in an operating theatre with anaesthetic and may be completed for a cosmetic or functional purpose. Many patients argue that their elective surgery is medically necessary because it improves their quality of life.

The major types of elective surgery procedures include:

Plastic surgery - cosmetic and reconstructive procedures such as a tummy tuck, facelift, or nose surgery may be done to improve a person’s appearance and self-esteem. 

Laser surgery - to correct vision problems.

Exploratory and diagnostic surgery - procedures to determine the extent of a medical problem, biopsy of tissue, or find where it originates.

Cardiovascular surgery - procedures that aren’t emergency but are needed to improve blood flow including the implant of a pacemaker. 

Gynaecological surgery - a patient may request and doctors may recommend an elective caesarean over a natural birth to reduce risks. A non-emergency hysterectomy or tubal ligation also makes up elective gynaecological surgery.

A surgeon marking lines on an elective surgery patient undergoing a consultation for their cosmetic surgery.

A doctor may recommend a patient to have elective surgery because it can improve the patient’s quality of life. A cataract operation can restore a person’s sight. An operation to fit a pacemaker may reduce the chance of emergency surgery in future. Diagnostic surgery may be the only way a doctor can determine the extent of a disease that increases the likelihood of future surgery.  

Due to the diversity of elective surgery, some state health departments group elective surgeries into categories such as:    
Category 1 (urgent elective surgeries) can quickly worsen into an emergency so the patient must be surgically treated within one month.

Category 2 (semi-urgent elective surgeries) are operations that relieve pain and hardship but are unlikely to worsen quickly to become an emergency. These patients should have surgery within 90 days. 

Category 3 (non-urgent surgeries) are operations that treat disease or disability that may cause pain but won’t deteriorate into an emergency. These patients should have surgery within one year. 

Surgical specialist doctors assess the patient for their condition’s severity and decide on the category. The hospital’s capacity and surgeon availability impacts the timeframe in which the elective surgery can be completed. At the beginning of the pandemic, elective surgery was placed on hold in all Australian states and territories due to lockdown periods and the number of COVID-19 patients in hospital. In some states, private hospitals and day clinics resumed at up to 50% of normal levels for the public health system to continue responding to COVID-19 matters.

A surgeon holds an elective surgery waitlist in a hospital waiting room.

Waitlist of Public Patients

Some states in Australia have experienced a significant increase in their waiting lists in 2022. Victoria, who had the longest lockdown period, had more than 87,000 people on the elective surgery waitlist in June 2022, an increase of 21,000 patients compared to the previous year.  

The WA waitlist had 29,141 patients in September 2021. Of these, 89.3% were scheduled to receive surgery within 30 days, 90 days, and one year. One year later, there were 28,560 patients on the waitlist, of which 76.7% of the cases had their operations allocated to the same time boundaries. These numbers didn't change significantly given the scale down in elective surgeries between March and May 2022. 

For September 2022 in WA, the following numbers illustrate the situation:

  • Category 3 had the biggest number of patients: 16,490 operated on within the boundary and 4,205 outside the one year boundary.
  • Category 2 has 4358 patients within the boundary and 2,115 over the 90-day boundary. 
  • Category 1 had 1064 patients within the 30 day boundary and 332 over it.    

Even before joining the surgery waitlist, Australians complain of long waiting periods to get an appointment with a surgeon. Waitlists hit the economy hard; state governments have greater spendings to try reducing waiting periods, and certain conditions stop people from working while they wait for surgery. The human toll is also high. Pain and reduced mobility means some waitlisted people are socially isolated from family, friends and their community. Their mental health can suffer as much as their physical health.

Two surgeons speak to each other while holding a patient waitlist, just before they go into theatre to perform elective surgery.

Waitlist of Private Patients

There are no elective surgery waitlists in the private hospital system. If a doctor advises a patient needs surgery, one can obtain a referral and visit a surgeon promptly. After seeing the surgeon, the patient can select a date for the operation. If the surgeon isn’t available when desired, one can book with another surgeon after getting a new referral from the GP. To avoid the time and cost of seeing multiple surgeons, the patient can contact the room to inquire about costs and the surgeon’s availability before arranging the appointment. 

Researching Your Surgeon

Your GP can provide a list of specialists and offer a recommendation, but you can also do your own research by visiting websites such as:

White Coat - directory site of healthcare professionals

Mind the Gap - to find and compare healthcare professionals

Health Share - to find a health professional and their answers to patient FAQs

Private health insurance allows policy holders to be treated in a private hospital using a surgeon of their choice. You may be treated in a public or private hospital as a private patient. Private health insurance covers some or all of the hospital accommodation costs. Medicare will cover some of the doctors’ costs and your health insurer covers some or all of the remaining doctors’ costs. You cannot claim against health insurance for seeing a doctor or specialist outside of hospital, only treatment while in hospital. 

Some health insurance policies cover some of the cost of prescription medicines not covered by the Pharmaceutical Benefits Scheme (PBS)

People without private health insurance can choose to self-fund the cost of a private hospital and specialist or doctor of their choice if they don’t want to wait for surgery on the public system waiting list. Regardless, this is not common as the cost can run into many thousands of dollars, particularly if there is a complication and the hospital stay is longer than expected. 

Seeing a doctor in a hospital outpatient clinic doesn’t mean you have been admitted to the hospital, which means the cost can’t be claimed on health insurance. Nevertheless, if you have a referral to see a doctor in a public hospital outpatient clinic and the treatment is on the Medicare Benefit Scheme, you can claim a rebate from Medicare. 

An elective surgery patient lies in a private hospital bed, recovering from their elective surgery.

Private Health Insurance Patient in a Public Hospital

People with private health insurance can be admitted to a public hospital and choose to be admitted as private or public patients. 

By choosing to be a private patient, you will receive a single room, if available, and additional perks depending on the hospital. The private hospital you attend will depend on your specialist doctor. The doctor has an arrangement with one or more hospitals to complete their surgeries there. If you want to stay in one hospital over another, check which hospital(s) your specialist operates at. Medicare would pay 75% of the hospital fees, and your private health insurer would usually cover the remaining costs. Regardless, there may be some out-of-pocket costs. Before deciding whether to be admitted as a public or private patient, ask your doctor for a cost estimate to make an informed decision. 

As a public patient, Medicare would cover the accommodation, the doctor and specialist fees, and medical and diagnostic service expenses. A public patient cannot choose their doctor or be placed in a single room. 

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Some Australians recognise that we have a world-class medical system in this country but it’s stretched. The public system has long waiting lists for surgeries that are needed to improve or maintain quality of life. Patients have been inclined to take out private health insurance so they and their family members have access to important elective surgery when desired and with a specialist of their choosing. Without hospital cover, one must rely on the public health waiting list.   

Waiting times for elective surgery are almost always high across the country. With certain HIF hospital cover policies, you'll have a much shorter waiting time for elective surgeries, you get to choose your hospital and doctor, and most importantly, have peace of mind knowing you're always covered.  

Tammy George

Please note: Tammy's blog is general advice only. For further information on this topic please consult your healthcare professional.

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