How are hospital cases managed within the Australian Health System?

Reviewed and updated 3 April 2024

Acute illness or trauma

If you arrive at a public hospital emergency department and are diagnosed with acute illness, traumatic injuries or a deteriorating existing condition, you will receive emergency surgery.

You can be:

admitted to hospital via an emergency department
a currently admitted inpatient who experiences a sudden deterioration
admitted to hospital via specialist outpatient services.

Depending on your condition, you will receive surgery within 1 hour to 10 days.

Elective surgery

If you are categorised as requiring surgery outside 10 days, you will be put into one of 3 categories:

Category	Description	Timeframe	Examples
Category 1	– has the potential to deteriorate quickly and may become an emergency	– procedures that are clinically indicated within 30 days	– breast lump removal or biopsy – neonatal surgery – malignant skin lesion – limb amputation
Category 2	– causes pain, dysfunction or disability – unlikely to deteriorate quickly – unlikely to become an emergency	– procedures that are clinically indicated within 90 days	– heart valve replacement – trigger finger release – congenital cardiac defect – nerve decompression – fracture that will not heal
Category 3	– 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	– carpal tunnel release – joint replacement – joint reconstruction – tonsillectomy – endometriosis – removal grommets

What does this mean if I need surgery?

If you want to enter the health system as a public patient under Medicare and you need elective surgery, you have to join a public waiting list. You might have to wait for months or even years for your surgery.

If you enter the health system as a private patient (after seeing a specialist who has recommended surgery), you can book in at your chosen private hospital. The waiting time may be only days or weeks.

This is one reason why people have private health insurance and use it to help pay for being treated in a hospital as a private patient.

How are hospital cases managed within the Australian Health System?

Acute illness or trauma

Elective surgery

What does this mean if I need surgery?

We promise

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