Need to know
- Elective surgeries resumed late April after being paused due to the coronavirus crisis.
- In late July Victoria again introduced restrictions to elective surgery.
- CHOICE calls for industry reform as many people are not getting value from their health insurance during the COVID-19 crisis
In late July, Victoria again introduced restrictions to all but the most urgent elective surgery.
In March, the government cancelled all elective surgery except what's classified as category 1 surgery and priority category 2. In April elective surgery started again for conditions that, although painful and potentially causing disability, are not expected to become an emergency.
Will my surgery get prioritised?
Private Healthcare Australia, the private health insurance industry's peak body, says that if your surgery has been cancelled or delayed and your condition has worsened, you should contact your specialist.
Specialists and hospitals will select patients based on:
- how urgent their condition is – but patients at high risk of adverse effects from COVID-19 may not get treated at this time
- location – hospitals in areas with known clusters of COVID-19 will have more limited resumption of surgeries
- type of surgery – day surgery will be preferred to procedures requiring post-operative care, for example in an ICU.
Procedures that will be re-introduced include:
- endoscopy and colonoscopy
- denture fittings and fillings
- hip and knee replacements
- plastic surgery after cancer such as breast reconstructions
- all surgery for children younger than 18 years of age.
What is elective surgery?
If surgery is called 'elective' it just means it's not emergency surgery and is 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, or your ability to enjoy and live your life could be severely limited.
There are three categories of elective surgery:
- Category 1 (urgent) – admission within 30 days as your condition can deteriorate and could become an emergency and possibly life-threatening. Examples are urgent cancer operations, a breast lump or skin lesion, limb amputations or urgent heart surgery.
- Category 2 (semi-urgent) – admission within 90 days. The condition can cause pain and disability but is unlikely to become an emergency. Examples are hernia, kidney and gallstones.
- Category 3 (non-urgent) – admission within the next year. The condition causes pain or disability but doesn't have the potential to become an emergency. Examples are cataract surgery and breast reconstruction after breast cancer.
CHOICE calls for reform
Private health funds are pocketing major profits during this time because of reduced hospital and extras claims. We believe the industry should be doing more to make sure these profits are handed back to their members.
"This pandemic has highlighted many of the problems and inequities in the private health insurance and hospital systems," says CHOICE health insurance campaigner Dean Price. "Surgeries have been cancelled and other services limited, and right now health funds are charging us for services we can't use."
"Until our health system is back to normal, people need relief from their health insurance premiums."
Right now health funds are charging us for services we can't useCHOICE health insurance campaigner Dean Price
In a recent CHOICE survey, 80% of people with private health insurance rated it as their number one cost of living concern – and that was before the global health and economic crisis brought on by the coronavirus.
"People will again be questioning the value of this product, and they will continue to drop out of this market unless the government takes strong action to review and improve the system," says Price.
"The problems of cost and value are not new to this pandemic, even if they are different. The Australian Government needs to commission a thorough, independent and public review of the private health insurance system."