Knowing whether you are an inpatient or outpatient is essential if you seek medical treatment.
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Medical treatments and surgeries can be classified into inpatient and outpatient care. While both types provide medical care, they differ in terms of where, for what duration patients are treated, and how they pay for it. Knowing whether you are an inpatient or outpatient is essential if you seek medical treatment and have a health insurance policy that will cover your medical expenses. So, what is the difference, and why does it matter?
Read on to learn about inpatient hospitalisation vs. outpatient hospitalisation.
The term ‘inpatient’ refers to someone who is admitted to the hospital for medical treatment. Most patients enter the inpatient hospitalisation through a pre-planned surgery or treatment or during emergencies. Inpatient care requires an overnight stay, whether briefly or for extended periods of time. In most cases, patients require in-depth observation and monitoring. Most of the hospitalisation falls under this and it is the most basic coverage of health policies. To categorise you as an inpatient and to receive the benefits of the insurance policy, you need to be admitted to the hospital, either planned or unplanned, for 24 hours.
For example, Mr. A suffered a heart attack and required surgery to clear the block in his artery. His doctor advised him to admit himself to the hospital for the required procedure. Mr. A was required to stay in the hospital for more than 24 hours for the surgery and required in-depth monitoring and observation by healthcare professionals. In this case, most health insurance policies cover such inpatient hospitalisation.
Serious illnesses such as stroke, flu, etc.
Chronic diseases, such as cancer that require specialised treatment
Childbirth (normal and cesarean section) - typically has a waiting period
Following are the different types of inpatient care.
Patients with serious health illnesses need in-depth monitoring and observation from healthcare professionals. Some severe health illnesses include seizures due to brain damage, respiratory problems, and being in a state of coma.
From bypass surgeries to organ transplantation of the heart, or other vital organs, complicated surgeries require long-term observation under the care of medical care professionals.
The term ‘outpatient’ refers to someone who requires medical care but without hospitalisation. Outpatient medical care includes doctor consultations, diagnostic tests, rehabilitation, etc. These procedures are conducted outside the hospital settings such as clinics, diagnostic centres, etc.
Health insurance coverage for outpatient hospitalisation is usually not covered until specified in the terms and conditions of the policy. If you foresee multiple doctor consultations in the near future, opt for a health insurance plan covering outpatient expenses. You can also include Out-patient Department (OPD) cover as an add-on to your base plan.
For example, Mr. B was suffering from the viral flu. He consulted a doctor at a nearby clinic. His doctor prescribed a few medicines and advised Mr. B to take enough rest and did not require in-depth monitoring or observation. In this case, some health insurance policies provide coverage for outpatient medical expenses.
Minor surgeries that do not require advanced medical care
Doctor consultations for minor illnesses
Medical screenings such as ECG, general blood check-ups, etc.
Certain types of treatments for long-term diseases such as chemotherapy, dialysis, etc.
Dental procedures or surgeries such as root canal treatment, extractions, implants, etc.
Following are the types of medical care/tests/consultations required by an outpatient.
Diagnostic tests help diagnose the cause of health issues such as abnormal heart rhythms, breathing problems, chest pain, etc.
Blood tests are required to check various health issues, including sodium, potassium, etc., that help regulate body functions.
This type of test is used to determine the causes of bladder infections, kidney pain, diabetes, etc.
These sessions are required to treat illnesses such as cancer since such treatments do not require an overnight stay in the hospital.
Here are the differences between inpatient and outpatient hospitalisation.
When the patient has been formally admitted to a hospital, either more than a day (at least 24 hours) or an extended period, the patient is called an inpatient.
When the patient does not require formal hospitalisation, the patient requires treatments performed outside the hospital setting; then, the patient is called an outpatient.
Type of medical care
Long-term: Complex surgeries, traumatic injuries, severe illnesses.
Short-term: Annual blood check-ups, minor surgeries, medical screenings, treatments, etc. that do not require hospitalisation.
Considerably higher than outpatient care.
Substantially less than inpatient care.
Specialists and a larger group of caretakers (physicians, surgeons, nurse practitioners, pharmacists, physical therapists, etc.
Primary care physicians and specialists (physician assistants, physical therapists, etc.)
Health insurance plans typically offer higher coverage limits for inpatient hospitalization compared to outpatient treatment. When you require inpatient care, such as staying in a hospital, undergoing surgery, or receiving intensive care, there are various expenses involved. These expenses may include room charges, fees for using the ICU, costs for using the operation theater, doctor fees, nursing charges, anesthesia, and more. In such cases, insurance companies provide a larger coverage limit, reimbursing a significant portion of the expenses incurred for your treatment. It's worth noting that many insurers have a network of hospitals where you can avail cashless treatments. Given the increasing costs of medical care, it's crucial to purchase a comprehensive health insurance plan that covers the expenses related to treatment and hospitalization.
Hopefully, you have learned a little more about inpatient and outpatient hospitalisation. Understanding the difference between inpatient and outpatient hospitalisation can help you identify the right type of plan for you and your family, when you are planning ahead for medical treatment or procedure, or anticipating medical expenses for both types of patient care.
Whether you need inpatient or outpatient care is entirely based on the type of medical care you require. Major surgery, intensive care, treatment of serious illness, and around-the-clock medical care are some examples that need you to be formally admitted to the hospital for an overnight stay or more. On the other hand, minor medical treatments, including minor surgeries, treatment, medical screenings, etc., do not require an overnight stay in a hospital.
Most health insurance plans are designed to provide health insurance coverage for inpatient care that requires you to be hospitalised for 24 hours. However, some plans are designed to provide coverage for outpatient medical care. You need to verify the terms and conditions of the policy before you can choose the right health plan for you.
Take time to choose the plan that suits you and your family’s requirements. If you foresee considerable medical expenses towards outpatient care, such as regular doctor consultations during maternity, you should consider opting for a health insurance plan that offers outpatient care. In comparison, an inpatient cover acts as a safety net against unforeseen emergencies and major surgeries that require hospitalisation for more than 24 hours.