Elective surgery is a type of surgery that's scheduled in advance as it doesn't involve a medical emergency. Generally, if your surgery can't be put off by more than 24 hours, then it's considered an emergency.
Elective doesn't mean unnecessary - after all, they can include cancer-related procedures or operations to address blood vessel problems - and some people will need their elective surgery performed sooner rather than later. So, doctors will monitor your condition and schedule your elective surgery according to how urgently you need it.
There are 3 levels of urgency doctors use to decide who's first in the queue for elective surgery: urgent, semi-urgent and non-urgent.
Here's how each is defined and what you can expect based on what category your surgery belongs to:
| Urgency Category | Definition | Examples | Maximum recommended wait time |
|---|---|---|---|
| Urgent | A condition that's an emergency, or could deteriorate quickly and become an emergency | Limb amputation, heart valve replacement | Admission within 30 days |
| Semi-urgent | A condition that causes some pain, dysfunction or disability but is not likely to deteriorate quickly or become an emergency | Hip replacement, prostate removal | Admission within 90 days |
| Non-urgent | A condition that causes minimal or no pain, dysfunction or disability, is unlikely to deteriorate quickly and does not have the potential to become an emergency | Varicose vein removal, septum reconstruction | Admission within 365 days |
Source: Bureau of Health Information (Jan-Mar 2021)
| Response | |
|---|---|
| I've never made a hospital claim | 36.7% |
| Gastrointestinal endoscopy | 9.93% |
| Other | 8.99% |
| Gynaecology | 8.8% |
| Dental surgery | 8.43% |
| Pregnancy and birth | 8.05% |
| Ear nose and throat | 7.3% |
| Cataracts | 6.74% |
| Heart and vascular system | 6.55% |
| Bone joint and muscle | 6.37% |
| Hernia and appendix | 5.43% |
| Cancer treatment | 4.87% |
| Eye surgery (not cataracts) | 4.49% |
| Joint replacements | 4.31% |
| Rehabilitation | 4.31% |
| Digestive system | 3.75% |
| Skin | 3.75% |
| Tonsils, adenoids and grommets | 3.75% |
| Pain management | 3.56% |
| Back neck and spine | 2.81% |
| Joint reconstructions | 2.81% |
| Sleep studies | 2.81% |
| Hospital psychiatric services | 2.62% |
| Male reproductive system | 2.25% |
| Lung and chest | 2.06% |
| Kidney and bladder | 1.87% |
| Blood | 1.69% |
| Brain and nervous system | 1.69% |
| Breast surgery | 1.69% |
| Weight loss surgery | 1.69% |
| Assisted reproductive services | 1.5% |
| Miscarriage | 1.5% |
| Pain management with device | 1.5% |
| Plastic or reconstructive surgery | 1.12% |
| Podiatric surgery | 1.12% |
| Palliative care | 0.94% |
| Diabetes management | 0.75% |
| Dialysis for chronic kidney failure | 0.37% |
Elective procedures are one of the main reasons people get private health insurance. Depending on your level of cover, private health insurance will cover a large number of elective surgeries. After all, everything except emergency, life-saving surgeries are considered to be elective.
There are some elective surgeries that are excluded from all but a few of the most premium policies, including weight loss surgery and in vitro fertilisation. Almost no policy offers cover for non-medical plastic surgery.
Getting private health cover lets you access treatment in a private hospital. In turn, you can get around some of the high wait times for elective surgery.
Private health insurance is available in a range of different tiers. That means the cost of health insurance for elective surgery is a bit like telling you how long a piece of string is. Here's a long list of hospital policies from Finder partners that offers some cover for elective surgery - they're all at the Bronze tier or above. All prices are based on a single individual with less than $93,000 income and living in Sydney.
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Recent figures from the Australian Institute of Health and Welfare show an average increase of 2.5%, each year, in the number of patients added to elective surgery waiting lists between 2014–15 and 2018–19.
Here are the procedures with the longest median wait times:
Surgery to correct a damaged nose bone: 277 days
Repairing a hole in the eardrum: 214 days
Replacement of weight-bearing surfaces of the knee: 223 days
In 2019–20, the median wait time for elective surgery (including urgent ones) in public hospitals was 39 days, with an unfortunate 2.8% having to wait more than a year.
The actual wait times may be even longer, because these figures only reflect the period of time between being added to the waitlist and being admitted for surgery. It doesn’t factor in the time it takes for prior check-ups and the time it takes to get put on the waiting list.
When you compare hospital health insurance policies, it’s important to understand what's covered and what's not. For example, if major eye surgery is excluded, then that means cataract removals won’t be covered.
Most brands offer three to four levels of cover: top, medium, basic and public hospital. What's included in each differs from brand to brand, but here is how the levels commonly look:
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