The impact of delay in elective cholecystectomy caused by preoperative state authorization requirements was retrospectively studied. The Student's t-test was used for statistical analysis. From 10/92 to 5/94, 146 patients were evaluated in an outpatient surgery clinic and elective cholecystectomy was planned. These patients were divided into two groups. Group 1 (101) patients waited for state authorization prior to cholecystectomy while group 2 (45) patients did not need state authorization. Group 1 patients waited an average of 112 days from the time of diagnosis to the time of surgery while group 2 patients waited an average of 21 days (P < 0.001). Group 1 patients were more likely to develop acute complications of cholelithiasis and require admission and urgent cholecystectomy than group 2 patients (22% vs 11%, P < 0.05). Group 1 patients requiring emergent treatment were found to have a longer hospital stay (P < 0.001), longer operative time (P < 0.05), and higher intraoperative blood loss (P < 0.005) than group 1 elective cases. Elective cholecystectomy patients who require state authorization have to wait longer prior to cholecystectomy and frequently develop acute complications of cholelithiasis requiring hospital admission and nonelective surgery. This translates into increased patient morbidity and added cost. State authorization requirements act as a barrier to providing timely care, add to cost, and must be considered in the current deliberations on health care policy.