3-step guide to accessing elective surgery in Australia

By HBF

2 minutes

15 January 2019

Your 3-step guide to accessing elective surgery in Australia
Last updated:

Australia’s health care system is widely recognised as one of the best in the world1.

Millions of hospital admissions occur every year, with most patients receiving high quality care in a timely manner.

Admissions to public hospitals are triaged to make the most of limited resources. If it’s an emergency, you will be seen straight away.

However, if you need elective surgery you will go on a public hospital waiting list and will be seen based on the severity of your condition relative to other patients.

This is where the private system comes in. Private hospitals specialise in non-emergency care and handle around two in three cases of elective surgery2.

Where you go for treatment—public or private—depends on your situation.

Emergency surgery is surgery which is medically necessary and requires attention within 24 hours, while elective surgery is surgery which is medically necessary but can be delayed for at least 24 hours. Also known as non-emergency surgery.

In an emergency, you will most likely go to the emergency department closest to you—the majority of which are attached to public hospitals.

If you need non-emergency surgery (known as ‘elective surgery’) you can go to a public or private hospital.

While there are many factors that go into this decision, the major considerations are the level of control you want over your experience and the amount of time you can expect to wait for surgery.

Step 1: General Practitioner (GP) Referral

Regardless of whether you ‘go public’ or ‘go private’ for elective surgery, your journey begins the same way: usually with a visit to your local GP.

If they’re unable to treat you and deem your condition requires more care, they will refer you to a specialist.

At this point, you can nominate whether you’d like to be a public or private patient.

Will you be referred to a specialist?

If you present to an emergency department and your situation is considered non-urgent or requires follow-up surgery, you may be referred to a specialist.

Going public

If you opt to go public, your GP will refer you to a hospital, who will then allocate your doctors. The doctors involved in your care may often include trainees.

The time between your first interaction with the health system (visiting your GP) and first seeing a specialist is known as the ‘wait-to-wait’, and is generally the longest part of the patient journey.

Referred to by some in the industry as the ‘hidden wait list’, data on the wait-to-wait is not included in reports on elective surgery waiting times, however, a separate report by the Western Australian Department of Health puts the median ‘wait-to-wait’ across all procedures in the WA public system at just under nine months3.

Going private

If you go private, your GP may provide several specialists that you can choose from, or you can request an open referral and do your own research. Alternatively, you can start by choosing a private hospital and the GP can provide a list of specialists that operate out of that hospital.

The time between your first interaction with the health system (visiting the GP) and your first appointment with a specialist can be significantly shorter in the private system—usually about two to three weeks.

Step 2: Specialist Appointment

Depending on the complexity of your issue, you may be referred for surgery at your first specialist visit, or you may need multiple consultations.

Once the specialist has diagnosed your issue, they’ll either provide treatment or recommend you for elective surgery.

Going public

If you need surgery, you will be placed on the public hospital waiting list—which is when your ‘official’ waiting time (the time captured in majority of waiting time reports) begins.

Based on the specialist’s assessment of your condition, you will be allocated one of three urgency categories that will help inform how long you wait for surgery.

Category
Clinical description
Desirable waiting time
Category 1 - Urgent
  • Has the potential to deteriorate quickly to the point where it may become an emergency
Admission within 30 days
Category 2 - Semi-urgent
  • Causes pain, dysfunction or disability
  • Unlikely to deteriorate quickly
  • Unlikely to become an emergency
Admission within 90 days
Category 3 - Non-urgent
  • Causes pain, dysfunction or disability
  • Unlikely to deteriorate quickly
  • Does not have the potential to become an emergency
Admission within 365 days

These categories represent what the government deems as acceptable timeframes between placement on the public hospital waiting list and receiving surgery.

However, they are also just targets—the time you will actually wait varies significantly between procedures. Variation also occurs for the same procedure at different hospitals.

In the public system you cannot choose your hospital and must serve the waiting time for the hospital you have been designated.

As soon as a spot becomes available, you will be contacted with a date for your surgery.

Going private

There are no waiting lists for elective surgery in the private system. If your specialist determines you require surgery, you simply book in a hospital date with the specialist’s receptionist.

The date you book is up to you, the only variables being the availability of the specialist and, at times, their estimation of how urgently you need surgery.

This is consistent for all patients, across all private hospitals and procedures.

Advantages of going private

In addition to shorter waiting times, the ability to select your date for surgery is a major advantage of going private. If you have a holiday booked or urgently need to recover to get back to work, surgery can be booked at a time that suits you. If you’re in the public system, the date of surgery is out of your hands, and is entirely dependent on progression through the public hospital waiting list.

Step 3: Ready for Surgery

When your surgery date arrives, provided your specialist deems you fit for surgery, you will go into hospital for your operation.

Going public

When you go into a public hospital for treatment, surgery often involves a team of doctors, including trainees. It is also likely you will stay in a shared room, unless your condition means you need a private room (for example, if you’re contagious).

Sometimes, the date of your surgery may be postponed if a patient is in a more critical condition than you—this is because hospital beds in the public system are in short supply, and will always be given to patients who need them most.

Going public as a private patient

You can also use your private health insurance in a public hospital. Some reasons for doing this include living in a rural area that only has a public hospital, or if a public hospital is closest to your home.

As a private patient in a public hospital, you can choose your doctors and if you’re covered for it, you’re also entitled to a private room where one is available. You will be placed on a public hospital waiting list to access elective surgery.

Going Private

In a private hospital, your treatment will be provided by a team of experienced specialists. You will also gain access to a private room (so long as you’re covered for one and it’s available).

It’s at the point of admission to hospital that your private health insurance kicks in—it provides cover for ‘inpatient’ services. All consultations prior to admission are considered ‘outpatient’ services, and will be covered between Medicare and you.

Using private health insurance vs. self-funding

If you do not have private health insurance, you can still access private hospital care by paying for treatment out of your own pocket. This is called ‘self-funding’. Private treatment can get very expensive, so most people choose to use private health insurance to help costs4.

 


Sources:
1 The Commonwealth Fund (USA) - What Would Happen If Health Care in the U.S. Improved? (2017)
2 Australian Private Hospitals - Voice of Reason (The Facts) (2016)
3 Department of Health - Referrals to public outpatient surgical clinics (2017)
4 AIHW - Admitted patient care (2017)