People without any doubt have understood the significance of having health insurance now more than ever, and are partnering with insurance carriers to make their wellness a priority. Individuals like you are showing keen interest in managing their health by having the right health insurance plan still, there are some blind spots in health insurance terminology. Health insurance professionals master such lingo with their years of experience, and as health insurance consumers you also need to devote time to understand different health insurance terminology. Among the several insurance terminologies, you need to have a clear understanding of the distinction between inpatient versus outpatient care. You should not only be able to understand the difference but should also know why does it matter to you and other policyholders.
Major Difference between Inpatient and Outpatient
An inpatient is a person who is admitted to the hospital for the overnight stay and can also include a patient who stays for weeks in hospitals to recover from a complicated surgery. It also includes individuals who need a brief stay in hospitals, so that doctors can closely monitor them. Outpatient care or ambulatory care is any medical service that doesn’t require hospitalization, such as an annual exam with a primary care physician, or a consultation with a neurologist are examples of outpatient care. If a patient leaves the emergency department the same day they arrive, then he/she will be considered an outpatient. In addition to these, any appointment at a clinic, or a specialty facility outside the hospital is considered outpatient care.
Determination of Inpatient Vs Outpatient
Sometimes, physicians keep patients under observation, while they determine whether a patient requires hospitalization or not. This gives them a little more time to evaluate the patient and take the appropriate decision. There are instances when a patient remains under observation status for more than 24 hours. It is not the location that determines whether you are an inpatient or outpatient, but it is the duration of stay that determines your status.
Comparing Inpatient Vs. Outpatient Services
The types of healthcare treatments and medical services that are included in both types of care are:
- Complex surgeries
- Severe injuries
- Delivering a baby
- Medical issues or illnesses that require substantial monitoring
- Rehabilitation services for psychiatric conditions
- Minor surgeries
- X-rays, MRI and other types of imaging
- Routine physical exams
- Consultations or follow-ups with a specialist
- Same-day emergency care and stitches
Inpatient Vs Outpatient Healthcare Providers
Primary care physicians are considered outpatient providers, whereas healthcare specialists are considered inpatient physicians. Hospitals generally bridge the gap by providing general medical care to inpatients. Effective healthcare requires a team effort, and doctors need to work together, irrespective of their specialty and setting. Doctors generally divide their time between inpatient and outpatient services, for example, gynaecologist provides inpatient care when delivering babies, and outpatient care when offering consultation to pregnant women during their prenatal check-ups.
Cost Consideration for Inpatient Vs. Outpatient
Patients might be thinking that whether the difference between inpatient and outpatient care matters to them. The patient should keep in mind that their status might not influence the quality of medical care they receive, but it might affect their eventual bill. The outpatient care cost comprises of fees that are charged for any type of test performed, and fees related to the doctor. The cost of inpatient care includes facility-based fees along with the existing expenses. This cost ranges anywhere from a few thousand dollars to tens of thousands of dollars, depending upon the stay duration, and the treatment procedure. The exact amount of inpatient care may also depend upon the patient’s insurance.
FAQ on Inpatient Vs. Outpatient Services
Inpatient service is any medical service that you receive after being formally admitted to a hospital. Some of the common inpatient medical procedures include severe injuries, complex surgeries, etc. You may be admitted to a hospital as either a day or overnight patient. Whereas outpatient services are any medical service that you receive without being formally admitted to the hospital. Some of the common outpatient medical procedures include visiting the hospital for tests, attending an outpatient clinic, or having a consultation with a specialist in a hospital. Until and unless you carry out all the admission formalities like filling out the paperwork and getting formally admitted you will not change over to inpatient services.
A patient who is not hospitalized overnight but who visits a hospital or a clinic for undergoing diagnosis or medical treatment is considered as Outpatient. Outpatient receives medical service without being admitted to a hospital or for a stay shorter than 24 hours.
Outpatient care is the fastest-growing segment in the market, and the prime reason behind its growth is the advancement in medical technologies, patient preferences, and financial incentives. It was discovered in a report that visits outpatient facilities such as urgent care centers, ambulatory surgery centers, and retail clinics rose by a significant percentage. The outpatient care market is steadily growing, as outpatient care has its advantages and the biggest advantage of outpatient care is the lower cost of these services, as these services are not subjected to hospital room charges or any other related fees. This makes outpatient substantially less expensive than inpatient care. Another reason cited for the growth of outpatient care was the easy and convenient recovery, as patients get to recover ay home following a visit to an ASC while receiving the same quality of care as in a hospital.
Health insurance plans including Medicare pay different rates for inpatient and outpatient care. Inpatient care is considered as more expensive because it includes the operating cost of the facility, whereas the price of outpatient care usually includes the cost of the test or procedure itself along with the physician’s fees. Inpatient care may cost from a few thousand to hundreds of thousands of dollars, depending on the duration of patient stay in the hospital and the type of treatment the patient received in the hospital.