Health
Wait times and costs for 6 common surgeries
This guide to costs and wait times to access Australia’s 6 most common surgeries for older Australians can help you work out whether it’s worth having treatment in the public system or paying a little more to go private.
By Sabrina Rogers-Anderson
Where did that hip pain come from and why are you suddenly squinting at the TV? With age comes wisdom… and a range of annoying health niggles and medical conditions.
While most of us would prefer to avoid surgery, sometimes it’s the best option to help us live a long and healthy life.
The good news? The cost of most medically necessary surgeries is covered by Medicare in Australia. The bad? Wait times for surgery in the public health care system can drag on (and on).
A report by the Australian institute of Health and Welfare found that the proportion of patients who waited more than 365 days for elective (planned) surgery in the public system was 9.6% in 2022-23, up from 2.1% in 2018-19.
Waiting times are significantly shorter in private hospitals with most patients accessing surgery within weeks, but this expedited treatment comes at a cost.
In addition to their private health insurance premium, private patients are likely to fork out a hospital excess (a fixed amount when they enter hospital) or co-payment (a daily amount while they’re in hospital) as well as some additional out-of-pocket costs for their surgery.
But for many Australians, the price tag may be well worth it to get the medical treatment they need without delay.
To help you plan for procedures you may need in the future, we’ve put together a guide of the 6 most common surgeries older Australians undergo with the average wait times in the public system and the average costs in the private system.
Comparing these figures will allow you to weigh up whether paying for private health insurance is worth it so you can get timely treatment when you need it. It’ll also ensure you take out a policy in time to ride out the waiting period before you need surgery.
The operations outlined below are all fully covered by Medicare, so they shouldn’t cost you anything in a public hospital.
The average cost as a private patient figures include out-of-pocket costs, but not hospital excess or co-payment. A hospital excess can be up to $750 for a single person or $1500 for couples or family cover, but you should check with your private health insurer.
To figure out exactly how much your out-of-pocket costs will be, ask your doctor for the Medicare Benefit Schedule (MBS) item numbers that apply to your procedure and how much will be covered by Medicare.
Then, call your private health insurance company and give them the MBS item numbers to find out how much they will cover.
When calculating your total costs, don’t forget to factor in your hospital excess or co-payment.
Before you read the 6 most common surgeries for older Australians, check out the health checks that can help pick up - or possibly prevent - nasty medical surprises.
1. Cataract surgery
A cataract is when the lens of your eye becomes cloudy. The risk of cataracts increases with age and most of us will have some degree of this eye condition by age 70.
Symptoms of cataracts include blurry vision, seeing colours as yellow or faded, sensitivity to bright lights and reduced night vision.
Cataract surgery involves removing the affected lens from your eye and replacing it with a plastic one. The operation takes less than 30 minutes and you should be able to go home the same day.
With 75,456 people having undergone cataract extraction in 2022-23, it’s the most common elective surgery in Australia.
Average wait time as a public patient: 50% of patients had surgery within 133 days and 90% had surgery within 384 days.
Average cost as a private patient: 56% of private patients had an out-of-pocket cost averaging $450 (plus any hospital excess or co-payment).
2. Bladder cystoscopy
During a cystoscopy, a doctor uses a thin tube with a camera and light on the end (cystoscope) to look inside your bladder.
This procedure can help diagnose bladder and urinary system conditions, including overactive bladder (OAB) and bladder cancer.
It’s usually recommended when symptoms such as difficulty urinating, frequent bladder infections, pain or blood in the urine are present.
While a flexible cystoscopy (with a flexible tube) can be performed in a clinic under local anaesthesia, a rigid cystoscopy (with a rigid tube) happens in a hospital under general or spinal anaesthetic.
A rigid cystoscopy is a day procedure (meaning you don’t need to stay overnight) and takes about 30 minutes.
More than 55,000 Australians had a cystoscopy in 2022-23.
Average wait time as a public patient: 50% of patients had surgery within 26 days and 90% had surgery within 161 days.
Average cost as a private patient: 52% of private patients had an out-of-pocket cost averaging $240 (plus any hospital excess or co-payment).
3. Gall bladder cholecystectomy
This tongue twister refers to surgery to remove your gallbladder, a small organ that stores bile to help you digest food.
Gallstones - small stone-like masses formed from undissolved cholesterol or bile - affect 15% of people aged 50 and over.
While many people with gallstones don’t have symptoms, others experience pain in the abdomen, back or right shoulder.
Other complications can include nausea and vomiting, jaundice, inflammation of the gallbladder (cholecystitis) and inflammation of the pancreas (pancreatitis).
Approximately 80% of people with symptoms will need their gallstones or entire gallbladder removed (cholecystectomy).
Gallbladder removal can be done through laparoscopic (keyhole) surgery or open surgery. You can expect to stay in a hospital for 1 to 2 days after a laparoscopic removal and up to 8 days following open surgery.
In 20022-23, more than 18,000 Australians had their gallbladders removed.
Average wait time as a public patient: 50% of patients had surgery within 59 days and 90% had surgery within 296 days.
Average cost as a private patient: 77% of private patients had an out-of-pocket cost averaging $480 (plus any hospital excess or co-payment).
4. Total knee replacement
A total knee replacement involves removing the damaged knee joint and replacing it with an artificial one.
Doctors will generally only recommend this surgery for severe knee pain that persists despite having tried other treatment options.
The most common reason for knee replacement surgery is osteoarthritis, but it can also be necessary for people with rheumatoid arthritis, haemophilia (a blood clotting disorder), gout or a bone growth disorder.
The majority of people who undergo a knee replacement are aged over 60. Having it too young (under 50) may result in needing a second knee replacement later on.
On average, knee replacement patients leave the hospital 1 to 4 days after surgery, but recovery can take up to 12 months.
There were 17, 528 knee replacements performed in Australia in 2022-23.
Average wait time as a public patient: 50% of patients had surgery within 308 days and 90% had surgery within 551 days.
Average cost as a private patient: 78% of private patients had an out-of-pocket cost averaging $880 (plus any hospital excess or co-payment).
5. Inguinal hernia repair
A hernia occurs when an organ, often the intestines, protrude through the abdominal wall. In the case of an inguinal hernia, the resulting lump occurs in the groin.
Men are 8 to 10 times more likely than women to get an inguinal hernia and the risk increases with age in both sexes.
Inguinal hernias are generally repaired with laparoscopic (keyhole) surgery or, more rarely, open surgery.
The laparoscopic procedure takes about 30 minutes under general anaesthesia while open surgery takes 45 minutes or so. You should be able to go home the same day or next day.
With 15,881 inguinal hernia repairs completed in 2022-23, it’s a commonly performed surgery in Australia.
Average wait time as a public patient: 50% of patients had surgery within 82 days and 90% had surgery within 381 days.
Average cost as a private patient: 69% of private patients had an out-of-pocket cost averaging $490 (plus any hospital excess or co-payment).
6. Total hip replacement
Your doctor will only recommend a total hip replacement if you’ve been experiencing ongoing pain that hasn’t been alleviated by physical therapy, medication or walking supports.
A total hip replacement involves removing damaged bone and cartilage from the hip joint and replacing them with plastic or metal parts.
The main reasons for having a hip replacement include osteoarthritis, rheumatoid arthritis, a hip injury and hip disease.
While the surgery itself only takes 1 to 2 hours, you’ll most likely have to stay in hospital for 3 to 5 days.
While you’ll be encouraged to be gently active as soon as possible, it can take up to 12 months to recover and most hip replacements need to be redone after about 10 years.
Nearly 12,000 total hip replacements were performed in Australia in 2022-23.
Average wait time as a public patient: 50% of patients had surgery within 175 days and 90% had surgery within 486 days.
Average cost as a private patient: 81% of private patients had an out-of-pocket cost averaging $1000 (plus any hospital excess or co-payment).
Weighing wait times versus cost
If you suspect you’ll eventually need one of these common surgeries, it may be worth taking out private health cover and putting money aside to cover your out-of-pocket costs.
Not only will you wait a fraction of the time to have your operation, but you’ll also be able to choose your doctor and have access to better continuity of care. That peace of mind is priceless.
It’s also vital - not to mention cheaper! - to look after your health and do the health checks and screenings recommended for your age.
The information on this page is general information and should not be used to diagnose or treat a health problem or disease. Do not use the information found on this page as a substitute for professional health care advice. Any information you find on this page or on external sites which are linked to on this page should be verified with your professional healthcare provider.
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