Top 10 most expensive surgeries and expected wait times

It’s a sad fact of life that the longer you live, the more maintenance your body generally needs – and planning for those costs can be challenging.

When you think about the most expensive surgeries in Australia, you probably think of severe medical issues such as heart transplants, but some of the most common surgeries many Australians need as they age are high on that list.

A hip replacement is the fourth most expensive surgery in Australia, and is also becoming one of the most common. According to the Australian National Joint Replacement Registry, 51,894 hip replacements were performed in 2022, which is 95 per cent higher than a decade prior.

Top 10 in order of cost

1. Transplants: $40,000-$150,000. No matter what organ is involved, transplants rank as the most expensive surgeries, with costs ranging from $40,000 for a kidney to close to $150,000 for a heart or liver. Public hospital wait time: Liver or heart: Nine-plus months; kidney five to seven years. Note that the surgeries are often performed rapidly once a suitable transplant becomes available.

2. Coronary artery bypass graft: $44,000. This invasive procedure, aimed at improving heart blood flow, involves grafting a healthy vein or artery to bypass blockages. Public hospital wait time*: 18 days.

3. Spinal fusion: $42,000. Spinal fusion, addressing chronic lower back pain from degenerated discs, entails surgically joining two or more bones in the spine. Public hospital wait time: 12 to18 months.

4. Hip replacement: $25,000. Common among older people, a hip replacement aims to alleviate pain and improve mobility by replacing a worn-out hip with an artificial one. Public hospital wait time: 120 days.

5. Colorectal surgery: $25,000. Involving the removal of part or all of the colon or rectum, this surgery is prompted by conditions such as cancer or Crohn’s disease. Public hospital wait time: 15 days.

6. Knee replacement: $23,000 Similar to a hip replacement, a knee replacement aims to relieve pain and enhance mobility, especially for arthritis sufferers. Public hospital wait time: 223 days.

7. Gallbladder surgery: $17,000. This addresses gallbladder issues via a small keyhole incision. Public hospital wait time: 30 to 90 days.

8. Pacemaker insertion: $16,000. A pacemaker regulates heart rhythm through electrical impulses. Public hospital wait time: 30 to 90 days.

9. Angioplasty and stent insertion: $16,000. Both procedures increase blood flow in veins and arteries. Public hospital wait time: 30 days

10. Prostatectomy: $16,000. This involves removal of the prostate and addresses such conditions as prostatitis and prostate cancer. Public hospital wait time: 44 days.

*Note: Wait times are based on the longest median waiting times for elective surgeries in public hospitals across the country for 2019-2020. This varies by state, and also depends on whether the surgery is classified as ‘urgent’ or ‘elective’.

And the cost?

When it comes to medically necessary elective or semi-elective surgeries, the overall cost varies based on surgeons’ fees and specific medical requirements (such as allergies to certain medications). For those with private health insurance, some of the costs can also be determined by the insurer.

Can Medicare help? What about private health insurance?

Medicare covers some of the above treatments for public patients in a public hospital, so long as they’re deemed medically necessary. Medicare cover includes:

  • operating theatre fees 
  • necessary surgical consultations 
  • medically necessary surgeries.

Medicare doesn’t cover all of the hospital accommodation costs for non-essential surgery – and that’s a big part of the surgery bill. The remainder is paid either by your private health insurer, or by you.

Some insurers offer a ‘medical gap scheme’ to assist with any additional costs, with private health insurance covering some or all of the gap, depending on the procedure. Actual out-of-pocket expenses for a specific surgery will vary based on individual needs.

If you’re a public patient in a hospital, Medicare only covers all your medical expenses if your surgery is medically necessary. If you’re a private patient in a public hospital, Medicare subsidises your doctor’s fees.

If you’re not covered, you’ll have to foot the bill for any part of your hospital visit that isn’t covered by Medicare.

The bottom line

Some of the most common medical procedures are also the most expensive, such as hip and knee replacements.

Medicare might cover some costs, but it won’t cover all of a hospital stay. That’s on your private health insurer if you’re covered, and on you if you’re not.

Your private health insurance can combine with Medicare to cover up to 100 per cent of the Medicare Benefits Schedule (MBS) for surgical costs in a hospital. Check with your insurer as to your policy includes gap cover.

Also read: ‘Exploding’ incidence of chronic disease must be tackled now, say GPs

This article originally appeared on Compare Club’s Expert Analysis and is republished with permission.

Note: YourLifeChoices is owned by Compare Club.

Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.

Leave a Comment

Your email address will not be published. Required fields are marked *