Need to know
- Elective surgery is a medically necessary surgery that is not needed immediately (i.e. it's not an emergency)
- There are pros and cons to undergoing surgery in both private and public hospitals
- Private hospitals are expensive, but you may have to wait longer for treatment in the public system
Elective, or planned, surgery accounts for around 70% of hospital admissions, and two thirds of these surgeries take place in private hospitals.
In Australia, you can choose between the public and private system for your surgery. Private hospital stays are expensive, but you can choose your doctor and they typically offer a more comfortable experience. While hospital insurance will subsidise your stay in a private hospital, you’ll usually have out-of-pocket costs to pay as well.
On the other hand, undergoing surgery in a public hospital is essentially free, but there’s generally a much longer wait for treatment.
On this page:
- What is elective surgery?
- Should I go public or private?
- How long are public hospital waiting lists?
- How much does a private hospital cost?
- Can I buy private health insurance just for my surgery?
What is elective surgery?
If surgery is called 'elective' it just means it's not emergency surgery and may be delayed at least 24 hours. It is necessary, but it's not immediately needed to save your life.
You may still be in a life-threatening situation if it's delayed too long, and it's possible that you can become disabled while waiting, for example if you're waiting for a hip or knee replacement surgery. Or your ability to enjoy and live your life could be limited, for example, if your eyesight worsens while waiting for cataract surgery.
There are three categories of elective surgery.
- Category 1 (urgent) – admission is recommended within 30 days as your condition can deteriorate and could become an emergency and possibly life-threatening. Examples include urgent cancer operations, a breast lump or skin lesion, limb amputations or urgent heart surgery.
- Category 2 (semi-urgent) – admission is recommended within 90 days as the condition can cause pain and disability but is unlikely to become an emergency. Examples include hernia, kidney and gallstone surgery.
- Category 3 (non-urgent) – admission is recommended within the next year as the condition causes pain or disability but doesn't have the potential to become an emergency. Examples include cataract surgery and breast reconstruction after breast cancer.
The most common elective surgeries are cataract surgery and cystoscopy (an endoscopy to find problems with the urinary tract or bladder such as stones, infection or cancer).
Should I go public or private?
Most people who are treated at a private hospital have private health insurance to help with the cost. Your private health fund pays a considerable amount towards your treatment, but there are additional costs you have to pay too. You can pay to go to a private hospital if you don't have private health insurance. This is called self-funding.
In addition to skipping public hospital waiting lists, when receiving treatment at a private hospital you'll be able to choose your own doctor, be more likely to get your own room, and probably be more comfortable and eat nicer food than in a public hospital.
Anyone with a Medicare card can choose to go to a public hospital and be treated for free as a public patient, even if you have private health insurance. And if you have complex health needs, or live in a rural area, you might have to go to a public hospital anyway, because they may be better equipped to treat your specific condition.
Anyone with a Medicare card can choose to go to a public hospital and be treated for free as a public patient, even if you have private health insurance
If you're treated as a public patient you won't be charged for doctors' fees, medication, accommodation or operating theatre fees. There may be some small extra costs for TV or Wi-Fi connection (if you choose to use them), but that's about it. You won't get to choose your own doctor, and you will have to wait until your surgery can be scheduled. The waiting time depends on many factors including the availability of a surgeon, the category your procedure falls into and how many other people need surgery at the time.
There's also the option to be treated as a private patient in a public hospital . You'll still need to join the waiting list for surgery, but you might get other perks like your own room, if one's available, and the option to choose your doctor. Your private health fund contributing to your hospital stay can benefit the public hospital, but the catch is that this sometimes opens you up to other out-of-pocket costs like doctors' or anesthesia fees, and your private health insurance excess (though sometimes this is waived).
How long are public hospital waiting lists?
One of the primary reasons Australians take out private hospital insurance is to avoid public waiting lists. So, how long are they really?
The median waiting time for all procedures in 2023–24 was 46 days. This is based on 780,000 patients who were admitted to surgery from public hospital waiting lists in 2023–24, according to the Australian Institute of Health and Welfare.
The median wait times for the most common surgeries in each state are listed below.
Overall, about 6% of patients wait for longer than a year for their elective surgery. This includes, across Australia:
- nearly 7% of cataract surgeries
- more than 30% of myringoplasty/tympanoplasty surgeries (operations to repair a hole in the eardrum)
- Nearly 40% of septoplasty surgeries (repairing a deviated septum)
- Over 25% of knee replacements and about 16% of hip replacements surgeries.
If you have private health insurance, you can shorten your wait time by selecting your own doctor and having your surgery in a private hospital. Compare health insurance policies to make sure you're getting the best deal.
How much does a private hospital cost?
You can get an idea about how much your procedure will cost in a private hospital using the medical cost finder. This shows how much of the total cost is usually covered by private health insurance, and how much is covered by Medicare, giving you a sense of the out-of-pocket costs that you'll have to pay.
You can also use the medical costs finder to estimate pricing as a self-funded patient, but you'll have to pay all the costs not covered by Medicare. Our experts have compared the cost of self-funding compared with taking out top health insurance. Sometimes it can be a good option.
Can I buy private health insurance just for my surgery?
If you know well in advance that you're going to need surgery, you can take out private health insurance in preparation, and then drop it after you've received treatment. But you need to be aware of the waiting periods for pre-existing conditions.
Hospital insurance policies generally have a waiting period of 12 months before they cover pregnancy and birth, or pre-existing conditions. Except for psychiatric care, rehabilitation and palliative care, for which there's only a 2-month wait.
This means that you'll be paying your premiums for at least a year before your surgery, which must be taken into account when comparing costs. These waiting periods apply when you take out a new policy and to any additional treatments covered by a higher tier policy if you upgrade from a lower one. Waiting periods don't apply if you switch to a new policy that has the same (or lower) level of cover.
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