Coronavirus, Elective Surgery & Your Private Health Insurance

Elective surgeries temporarily suspended

To ensure the health system could cope with the coronavirus outbreak, on March 25 2020 the Federal Government temporarily suspended all non-emergency elective surgery (most category 2 and all category 3) in both public and private hospitals.[1]  However, category 1 elective surgery (including pregnancy and birth, as well as urgent heart and cancer procedures) was still continuing.

The postponement of non-urgent elective surgery was designed to preserve critical resources when they are most needed including beds, hospital staff and medical supplies. This aims to ensure there are adequate resources for all Australians who need emergency treatment, not just coronavirus patients.

Doctors, nurses and midwives from Australia’s private hospitals have also been made available to fight the coronavirus pandemic. Half the cost of the integration of the private and public sectors will be worn by the federal government.[2]

Some non-urgent elective surgeries recommence

With the rate of coronavirus cases in Australia declining throughout April, on 21 April 2020 the Government announced that from 27 April 2020, all category 2 and some important category 3 procedures would recommence in both public and private hospitals.[3]

Those elective procedures which recommenced from 27 April 2020 include IVF, screening program, breast reconstruction, joint replacements, cataracts and eye procedures, endoscopies, colonoscopies and all procedures for children under 18 years of age.

So will my elective surgery be going ahead?

That depends on the type of elective surgery you are having (including what category it falls into) and where you had planned to be treated. 

So, what happens if you have an upcoming elective surgery and are in limbo not knowing which category you fall in?  When it comes to elective surgeries there are three categories with Category 1 being the most important.[4]

Category 1: Urgent cases

Treatment within 30 days is desirable for a condition that has the potential to deteriorate quickly to the point that it might become an emergency.  Note childbirth is also considered category 1.

Category 2: Semi-urgent cases

Treatment within 90 days is desirable for a condition that is causing pain, dysfunction or disability but which is not likely to deteriorate quickly or become an emergency.

Category 3: Non-urgent cases

Treatment at some time in the future is acceptable for a condition causing minimal or no pain, dysfunction or disability that is very unlikely to deteriorate quickly and does not have the potential to become an emergency. Treatment within 12 months is used as a guide.

Although elective surgeries fall into these three categories, there are also some varying factors such as your general health and wellbeing, and any deterioration, that also need to be considered by your doctor that could change your categorisation or when your surgery is likely to go ahead.[5] 

Your surgeon will reschedule your surgery

If your surgery falls into one of the categories and procedures that are now able to recommence, it will need to be rescheduled. You should contact your surgeon for more information on when your surgery is likely to take place. 

Remember, hospitals and surgeons will reschedule surgeries according to clinical need.[6] 

Will my elective surgery be delayed?

Possibly.  Keep in mind that given that most elective surgeries were suspended for almost a month, there is a likely to be a backlog of surgeries which could result in ongoing delays.[7]

Although this may be frustrating, Australia needs to relieve the pressure on the public system and reserve critical medical resources for tackling the coronavirus outbreak.

What if my condition deteriorates?

There is always a possibility if you condition worsens, and it is significantly affecting your health and wellbeing, your doctor may revaluate and schedule your procedure. While you are in this waiting period, it’s important you keep in contact with your GP and remain fit and healthy. Immediately consult your doctor if you believe your condition is deteriorating.

The value of private health insurance?

One of the key advantages of private health cover is generally shorter waiting times for elective (or non-life-threatening surgery).  Normally, waiting times for elective surgery in the public system are around 4.5 times longer than in the private system.[8] However, on the resumption of elective surgery from 27 April 2020, it is expected that patients will be treated on the basis of clinical urgency, rather than whether they are a public or private patient.

Given a backlog of elective surgery is possible due to coronavirus, when the pandemic subsides having private cover could help you have your elective surgery sooner than those patients relying on the public system.

[1] Source: https://www.pm.gov.au/media/elective-surgery

[2] Source: https://www.theguardian.com/australia-news/2020/mar/31/federal-government-pay-half-integrate-private-public-hospitals-covid-19-response

[3] Source: https://www.pm.gov.au/media/update-coronavirus-measures-210420

[4] Source: https://www2.health.vic.gov.au/about/publications/data/What-do-I-need-to-know-about-my-elective-surgery-brochure

[5] Source: https://www.premier.vic.gov.au/elective-surgery-wound-back-to-prepare-for-coronavirus/

[6] Source: https://www.privatehealthcareaustralia.org.au/good-news-for-patients-as-elective-surgery-to-resume/

[7] Source: https://www.privatehealthcareaustralia.org.au/health-funds-postpone-1-april-premium-increase/

[8] Source: Ipsos Healthcare & Insurance Australia 2019