Health Insurance for Elective Surgery and Waiting Lists in Australia
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If you’re planning knee replacement surgery, skin cancer removal, cataract extraction or to start IVF treatment chances are you’ll be added to an elective surgery waiting list. Because elective surgeries are deemed medically necessary but don't need to be done within 24 hours, you can expect to wait an average of 38 days.
Waiting times vary across states and territories, from 28 days in the Northern Territory to 54 days in New South Wales.
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Elective surgeries in Australia are on the rise, increasing by 2.8% on average in the last year. According to the Australian Institute of Health and Welfare (AIHW), between 2016 and 2017 about 748,000 patients were admitted to Australian public hospitals for elective surgery.
Health insurance for elective surgery in Australia should in theory not have an impact on your waiting time, as it ought to be driven by clinical needs. However, despite Medicare’s ability to cover elective surgeries, excessively long waiting periods have become the norm. Private health insurance patients have long been known to have a shorter wait for elective operations in the public system.
However, such instances where private patients receive non-emergency surgeries more quickly than public patients should not be the norm. Under the Australian health care agreement, the time a patient must wait for elective surgery should be reflected in their urgent need for care.
Elective procedure examples include, carpal tunnel release, surgical removal of the gallbladder, cataract extraction, total hip or knee replacement, removal of haemorrhoids, and hernia repair.
What is an elective surgery waiting list?
In public hospitals, an elective surgery waiting list refers to a list of patients registered to receive elective surgery. Your treating doctor usually determines how urgent your surgery is and will then assign you to one of the three elective procedure categories. The time you can expect to wait for surgery depends on the group you are assigned to.
Elective surgery categories and waiting times
|Category||Description||Average Waiting Time||Procedure Examples|
Is elective surgery covered by Medicare?
Yes, Medicare covers elective surgeries which are considered medically necessary. However, you need to provide documentation from your doctor establishing that your surgery is required. After you’ve had a consultation with your surgeon, you will be put on the elective surgery waiting list determined by your urgency category.
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Elective surgery waiting lists in Australia
All Australian states are experiencing waiting list problems because public hospitals can no longer meet the high demand for elective surgeries. In South Australia, patients wait an average of 1 week longer than expected, while in Tasmania 8.8% of people are waiting more than 365 days.
Possible reasons behind these long waiting times include Australia’s ageing population, longer life expectancy and the increase in the prevalence of conditions where elective surgery is the most appropriate treatment.
Waiting times for elective surgery by state
|Territory||Expected Waiting Times|
|Western Australia||34 days|
|Southern Australia||39 days|
|Australian Capital Territory||46 days|
|Northern Territory||28 days|
Frequently asked questions and answers
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