Elective Surgery: Do I need Private Health Insurance?

Even though Australia does have a good public health system, there are still several reasons why you might want to consider private health insurance.

As much as we like to complain about it sometimes, Australia has a terrific public (and free) health system that ensures in the event of an accident or other emergency, you will receive world-class medical assistance. This is true whether you live in the city or even, thanks to the Royal Flying Doctor service, in the outback. It’s expensive assistance; according to the 2016 Federal Budget papers, health expenditure alone accounts for almost 16% of all spending.

Despite the expenditure and the dedicated staff, there are many medical situations that you might experience where private health insurance can come in very handy. That’s because, when it comes to being treated at a public hospital, the seriousness of your injury or illness determines how quickly you’ll receive treatment. You may end up on a long waiting list if your condition is not serious or is elective.

Other benefits of private health insurance

What is elective surgery?

Elective surgery is a procedure that you plan for and schedule in advance, rather than a procedure performed under emergency conditions. Examples of elective surgery might be a tonsillectomy or a caesarean.

Hospitals consider elective surgery in several different categories, ranging from urgent to semi-urgent to non-urgent. As an example, the WA Department of Health categorises elective surgery categories as follows:

Why should you have health insurance
Category Clinical Description Meaning
1 – Urgent Has the potential to deteriorate quickly to the point where it may become an emergency. Procedures that are clinically indicated within 30 days
2 – Semi-urgent
  • Causes pain, dysfunction or disability.
  • Unlikely to deteriorate quickly.
  • Unlikely to become an emergency.
Procedures that are clinically indicated within 90 days
3 – Non-urgent
  • Causes minimal or no pain, dysfunction or disability.
  • Unlikely to deteriorate quickly.
  • Does not have the potential to become an emergency.
Procedures that are clinically indicated within 365 days
Source: WA Department of Health, 2016

Needing a knee reconstruction, for example, might affect your ability to work, but it’s not life-threatening so you may be waiting a long time for it. Having a child with suspected anaphylaxis to certain foods isn’t likely to be classed as an emergency even though exposure to those foods could potentially be life-threatening.

Overall there are hundreds of non-emergency situations that might occur in your life. Without private health insurance you have the choice of paying for treatment for these things out of your own pocket or dealing with the impact on your quality of life for months or years.

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How long do people really wait for elective surgery?

The good news is that most Australians are seen for elective surgery in an acceptable timeframe. According to the most recent data collated by the Australian Institute of Health and Welfare, in 2014/15 50% of all patients were admitted for elective surgery within 35 days of being placed on the waiting list. 90% of all patients were admitted within 253 days. 10% waited longer than these times.

The wait was shortest on average in Queensland and longest in Tasmania.

Australian Institute of Health

Source: AIHW

It is worth noting that the waiting time data measures the period that starts when a patient’s name is added to the hospital’s waiting list for surgery, and ends when the patient is admitted to hospital to undergo that surgery. It doesn’t include the earlier period of time when a patient may be waiting to be added to the hospital’s list in the first place!

Public vs Private Health Insurance

As much as we like to complain about it sometimes, Australia has a terrific public (and free) health system that ensures in the event of an accident or other emergency, you will receive world-class medical assistance. This is true whether you live in the city or even, thanks to the Royal Flying Doctor service, in the outback. It’s expensive assistance; according to the 2015 Federal Budget papers, health expenditure is approximately 16% of all spending.

Despite the expenditure and the dedicated staff, there are many medical situations that you might experience where private health insurance can come in very handy. That’s because, when it comes to being treated at a public hospital, the seriousness of your injury or illness determines how quickly you’ll receive treatment. You may end up on a long waiting list if your condition is not serious. Needing a knee reconstruction, for example, might affect your ability to work, but it’s not life-threatening so you may be waiting a long time for it. Having a child with suspected anaphylaxis to certain foods isn’t likely to be classed as an emergency even though exposure to those foods could potentially be life-threatening.

We’ve written about more of the differences between public and private health here and the other benefits of private health insurance apart from help paying for elective surgeries.

Overall there are hundreds of non-emergency situations that might occur in your life. Without private health insurance you have the choice of paying for treatment for these things out of your own pocket or dealing with the impact on your quality of life for months or years.

Compare Health Insurance

More benefits of private health insurance

Learn more about Health Insurance

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