OBJECTIVE To assess the existence and content of elective admission policies in New South Wales acute public hospitals. METHODS A questionnaire was sent to managers of all acute public hospitals (n = 76). Copies of elective admission policies were sought from respondents. Results were analysed with EpiInfo 5.01b and policy content by thematic analysis. RESULTS Survey response was 91% (69/76). Policies existed in 71% (49/69) of hospitals. Of these, 96% (47/49) disseminated their policy, with 23% (11/47) disseminating it at least annually, 41% (19/47) only when updated, and 32% (15/47) infrequently, with one policy being new (2%) and one hospital not stating its frequency (2%). Policy compliance was assessed in 86% (42/49) of hospitals and guidelines reviewed periodically in 92% (45/49) of hospitals. Twenty per cent (10/49) of the policies had been developed since a departmental instruction of May 1994. Of the 20 acute hospitals with no policy, 75% (15/20) were rural and 85% (17/20) thought they should have a policy. Analysis of policy content revealed emphases on resource availability and clinical need as determinants of elective admission, an institutional rather than a patient focus, and a high level of senior nurse manager involvement in admission decisions in rural hospitals. CONCLUSIONS Despite a specific departmental instruction, nearly one-third of hospitals still had no admission policy 18 months later. This could be indicative of miscommunication between hospitals and NSW Health or perceived irrelevance of department guidelines by hospital managers. Existing policies were mostly institutionally focused and dominated by perceived resource limitations. NSW Health might consider other medico-social factors and manager involvement in future policy development.