Inpatient vs Outpatient
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What is Inpatient Insurance?
The duration of hospital stay depends on the ailment, type of treatment, and the observation required. But patients must stay in the hospital for at least one night to get inpatient insurance coverage.
What is Outpatient Insurance?
Only those insurance policies with OPD benefits shall cover outpatient expenses. You must buy a separate add-on cover if the basic plan does not cover outpatient expenses.
Difference Between Inpatient & Outpatient Care
The patient stays in the hospital for at least one night to receive medical treatment.
The patient receives medical treatment or consultation without getting admitted to the hospital
Long-term medical care that includes surgical treatments, hospital stays, ICU, etc.
Short-term medical care that includes diagnostic procedures, minor surgeries, and doctor’s consultations.
Thus requires very close monitoring & observation of the patient.
This does not require close monitoring & observation of the patient.
Healthcare Professionals Involved
Specialists and a team of medical professionals.
Healthcare Professionals Involved
A general physician and other medical specialists.
Cost of Treatment
Inpatient care expenses are much higher than outpatient care.
Cost of Treatment
Outpatient treatment costs are much lower than inpatient care
Available only if the hospital stay is for at least 24 hours.
Available only if the insurance policy provides OPD benefits
Advantages of Inpatient Care
An in-depth and complete investigation of the patient’s medical condition is possible through various tests.
The patient’s health condition is closely monitored & observed by medical professionals. The doctors & nurses provide constant care.
Inpatient departments of hospitals are equipped with modern facilities to perform complicated surgeries and treat heart ailments, kidney failure, severe accidental injuries, brain & neurological problems, etc.
High-quality medical care can be provided after childbirth, surgical treatments, and treatment for critical diseases.
Hospitalization for emergency medical treatments can save lives in cases of major accidents and life-threatening diseases.
Advantages of Outpatient Care
Many patients dislike the hospital ambiance and the restrictions that come along with it. So patients who are averse to a sterile hospital environment can choose to recover in the comfort of their homes after receiving basic treatment in a hospital.
Outpatient care costs are significantly lower than inpatient hospitalization. Patients with good health insurance coverage can also benefit from the huge savings in medical bills and reduce their claims.
Outpatient medical insurance helps you avoid out-of-pocket expenses on post-treatment care, such as doctor’s consultations, laboratory tests, and pharmacy bills.
Examples of Inpatient Care
Critical illnesses or health conditions that require constant monitoring of the patient.
Emergency care services to treat severe accidental injuries.
Medical treatments involving a prolonged recovery period.
Rehabilitation courses and therapies to quickly restore patients to their normal lives.
Implanting prosthetics and other equipment during surgeries.
Examples of Outpatient Care
Minor surgeries that do not require overnight hospitalization. E.g., cataract, hernia repair.
Preventive healthcare or periodic medical checkups.
Regular medical treatments such as chemotherapy, dialysis, and physiotherapy sessions.
Doctor’s consultations and follow-ups.
Laboratory procedures such as blood & urine tests, X-rays, CT scans, MRI scans, and biopsies.
Regular dental procedures such as tooth extractions, cavity removal, and root canal treatment.
Cost of medicines, injections, and vaccinations.
Why is Outpatient Care Lesser in Cost When Compared With Inpatient Care?
An outpatient insurance policy only covers those expenses where you do not require a hospital bed to stay overnight. This includes minor surgeries, consulting with doctors, laboratory tests, and pharmacy bills. These services can be availed in the outpatient department or clinics and do not require the facilities of a full-fledged hospital.
But inpatient health insurance covers far more complex and expensive services such as surgical treatments, use of medical equipment, room rent, OT & ICU charges. Constant supervision by doctors and nurses also adds to the cost of inpatient hospitalization.
Factors Affecting the Cost of Inpatient Care
The duration of stay in the hospital. The longer you stay, the more you pay
The type of treatment required for the patient and the availability of beds
The location of the hospital and the quality of the facilities it offers
The out-of-pocket expenses also depend on the deductible amount. This is the amount that you first need to pay before making a claim on your health insurance policy. A higher deductible can lower your premium.
Frequently Asked Questions on Inpatient vs. Outpatient
Major surgeries and treatment of serious diseases require you to get admitted to the hospital. So any treatment that requires you to stay at least 24 hours in the hospital is referred to as inpatient care. But outpatient care is for minor surgeries, medical checkups, and medicines. This does not need an overnight hospital stay.
Surgeries, treatment of chronic diseases, and accidental injuries require patients to be hospitalized for close monitoring of their health condition. If you are admitted to a hospital and placed under observation by the doctors, it will be categorized as inpatient care.
In maternity insurance, inpatient care covers all expenses related to normal & C-section delivery (ambulance, nursing, room rent, OT charges, and doctor’s fees). The outpatient insurance covers pre-natal and post-natal care expenses. A comprehensive maternity care plan covers both inpatient and outpatient benefits.
This depends entirely on the type of medical care you need. If the treatment requires you to be admitted to the hospital for an overnight stay or beyond, you need an inpatient health insurance plan. But choose an outpatient health insurance plan if you want to cover routine medical screenings, doctor’s consultations, pharmacy bills, etc., that do not require hospitalization.
Root canal treatment is a dental procedure that doe not require any overnight hospitalization. So it is considered to be an outpatient treatment.
Disclaimer: The inpatient and outpatient Insurance or plan may have limitations, exclusions, and other terms and conditions that may affect coverage. It is important to carefully review the policy wording before making any decision.