FOR EXISTING POLICY
FOR NEW POLICY
Inpatient care requires a hospital stay for more than 24 hours, and outpatient care does not. The main difference between inpatient vs outpatient care depends on the type of medical service required and whether you need to be hospitalised overnight.
Medical treatments and services can be classified into inpatient hospital services or outpatient care. They both fall under medical care, but the difference between them lies in the types of services offered under them.
Knowing the difference and what is inpatient and outpatient care is essential when seeking medical treatment, especially if you have medical insurance or a life insurance plan that offers medical coverage.
Difference Between Inpatient and Outpatient Care
Parameters |
Inpatient Care |
Outpatient Care |
Definition |
When the patient must be formally admitted to a hospital or inpatient facility for more than 24 hours. |
Medical treatment that does not require hospitalisation or the patient’s prolonged monitoring and care from medical staff. |
Type of Medical Care |
Long-Term Medical Care |
Short-Term Medical Care |
Treatment/Services Offered |
|
|
Cost |
Considerably Expensive |
Affordable to Expensive (Depends on the type of service) |
Healthcare Professionals Involved |
A larger group of caretakers. (Specialists, surgeons, physicians, nurse practitioners, pharmacists, physical therapists, etc.) |
Primary care physicians and specialists (Assistants, physical therapists, etc.) |
Does Insurance Cover It? |
Almost all medical insurance will cover inpatient hospitalisation costs. |
Is available as add-on coverage. Only some plans will offer it as a part of the base cover. |
What Is Inpatient Care?
Inpatient care services require in-depth observation and monitoring and are provided at hospitals or inpatient facilities, where you must stay overnight or for multiple days, depending on the treatment and your condition.
Most patients enter inpatient care through a pre-planned surgery, treatment or for medical emergencies. For example, surgery, childbirth, or treatment of traumatic injury can all fall under inpatient care, as they require hospitalisation for multiple days.
There are even inpatient facilities and hospitals for substance use and mental health care.
Under medical insurance, inpatient hospitalisation expenses are covered if you have been hospitalised for at least 24 hours, and the hospitalisation is for an insured illness/treatment or due to a medical emergency (e.g., heart attack, car accident, stroke, etc.).
Types of Inpatient Care
Serious Health Condtions
Patients with severe illnesses or health condtions that have drastically worsened, whose vitals must be monitored by healthcare professionals. Some examples include:
Chronic diseases like cancer or chronic obstructive pulmonary disease (COPD).
Seizures due to brain damage.
Respiratory problems, strokes or heart attack.
Being in a state of coma.
Severe mental health issues
Treatment for substance use disorder and overdoses
Complex Surgeries
These can be bypass surgeries, organ transplants of the heart or other vital organs, treatment for traumatic injuries due to major accidents and other complicated surgeries that require long-term observation under medical care professionals.
What is Outpatient Care?
Outpatient care is medical treatment you do not require hospitalisation for. This can be anywhere from an annual check-up or blood test to almost any other treatment, like diagnostic tests that do not require an overnight or extended hospital stay.
Outpatient medical treatments can be provided in a hospital, a walk-in clinic, an outpatient surgery centre, or even your doctor’s office.
In medical insurance, outpatient treatments or OPD care is defined as medical treatments that do not exceed 24 hours. Not all insurance will cover OPD treatments, and if they do, they will only cover expenses for a specific list of medical services up to a certain limit under the policy.
Types of Outpatient Medical Care
Blood Tests and Health Check-Ups
When discussing OPD care, blood tests and health check-ups are the most common services. Annual health check-ups can include some or all of the OPD services listed here, depending on your current health condition and medical history.
Blood tests are required to check abnormalities in your bloodwork. This includes checking sodium, potassium, or iron levels, RBC counts and other components that help regulate body functions.
X-rays and CT scans
These diagnostic tests help determine the cause of the illness or issue, like abnormal heart rhythms, breathing problems, chest pain, etc. and do not take more than a few minutes or a couple of hours.
Urinalysis
This type of test determines the causes of kidney disease, pain, bladder infections, diabetes, etc.
Dialysis and Chemotherapy Sessions
These sessions are required to treat illnesses and condtions like degenerative kidney disease and cancer, respectively. The treatments themselves do not require extended or overnight hospitalisation despite the severity of the illnesses and only take a couple of hours per session.
Minor Surgeries
Minor surgeries that do not need advanced medical care like Lasik, hand or foot surgery, dental procedures, minor cosmetic surgery, etc.
How to Decide If You Need Inpatient Vs Outpatient Care?
Whether you need inpatient or outpatient services is determined by the type of care you require.
Intensive, around-the-clock care for major surgeries and clinical illness treatment will generally fall under inpatient care.
Minor surgeries, treatments, diagnostic tests, and medical screenings that do not require overnight hospitalisation will fall under outpatient care.
Oftentimes, the actual patient does not get to choose between inpatient vs outpatient care when getting treated at healthcare facilities. The type of care they receive (and ultimately, the cost) will depend on how serious the hospital team thinks the medical condition or operation is.
Are There Any Exceptions to This?
Some treatments, like physical therapy, can be covered as inpatient or outpatient based on how it fits into your overall medical treatment. For instance, most insurers consider it a separate OPD treatment and will not cover it unless the policy states otherwise.
What are Inpatient Vs Outpatient Costs?
Inpatient Care Costs:
Inpatient medical care is considered more expensive than outpatient care. This is because medical care and inpatient services involve a larger group of caretakers and more hospital resources.
Hence, the costs for inpatient care can add up when considering the other costs associated with being cared for in a hospital, like:
Administrative costs,
Lab tests,
Pharmacy costs,
Costs for hospital staff like nurses, technicians, radiologists, and other specialists,
Equipment and supplies used for your care while you’re there.
Outpatient Care Costs:
Outpatient care is generally more affordable; in some cases, you also have more control over your costs. For example,
Costs for diagnostic tests can vary greatly, so shopping around for things like PET, MRIs, and CT scans can help keep your costs low.
For unplanned medical care, understanding the difference between urgent care and emergency care (life-threatening conditions) can ensure you don’t pay more than you need to.
Some health insurance policies will offer free annual health check-ups and OPD covers under their plans, so taking advantage of those covers can help curb your medical costs as well.
Inpatient Vs Outpatient Care In Insurance
Most basic health insurance policies and health riders in life insurance plans will offer inpatient care coverage for medical emergencies and insured treatments and providers. Depending on the type of plan, OPD care will be offered as a part of your base cover or as an add-on cover.
For example, you can get a Tata AIA OPD Care rider with your life insurance policy if you have a chronic health condition that requires regular treatments and check-ups.
If you have medical insurance coverage, it is best to check your policy wording on what treatments are covered under inpatient hospital services and OPD care to curb any unnecessary out-of-pocket medical expenses.
Conclusion
The key difference between inpatient and outpatient care lies in the types of services required and whether or not you will require hospitalisation for those services. Inpatient care is also more expensive than OPD care as it requires more resources to facilitate.
Your primary physician or hospital team will decide the type of medical care you need, depending on your diagnosis or medical condition. Hence, it is always best to know the differences between the two as it will make filing insurance claims much easier.
