Inpatient vs Outpatient Hospitalization: Which is Right for You?

What is Inpatient Hospitalization?

Inpatient hospitalization occurs when a patient is admitted to a hospital for medical treatment. Usually, it involves an overnight stay at the hospital for in-depth monitoring and observation. Inpatient hospitalization is usually required during a medical emergency or for a pre-planned surgery or treatment, such as severe burns, traumatic injury, childbirth, chronic diseases, etc.

All health insurance plans cover inpatient treatment if the patient has been admitted to the hospital for at least 24 hours. However, the extent of coverage offered by insurance companies is limited to inpatient hospitalization expenses incurred on:

Doctor’s fee
Room rent
Medicines and drugs
Intravenous fluids, injection and blood transfusion charges
Diagnostic tests
Consumables
Operation theatre charges
Intensive Care Unit (ICU) charges
Prosthetics and other equipment/devices implanted internally during a surgery

Let’s understand this with the help of an example.

Suppose Ram has been diagnosed with 90% blockage in his heart and requires major open heart surgery to clear the arteries. The doctor asked him to get hospitalized immediately and operated on him. He was kept in the ICU under constant observation for 2 days and was discharged after a week. In this case, Ram’s hospitalization is categorized as in-patient and therefore, his insurance company will pay for his hospital bills.

What is Outpatient Hospitalization?

Outpatient hospitalization occurs when a patient receives medical treatment without getting admitted to a hospital. These treatments are conducted in the outpatient department of a hospital, a clinic or a diagnostic centre.

A health insurance policy covers outpatient treatment expenses only if it comes with the OPD benefit. While some plans may have an in-built OPD cover, others may offer it as an add-on benefit. As part of the OPD benefit, the insurance company will pay for the outpatient medical expenses incurred on:

Doctor consultations
Diagnostic tests, such as X-rays, blood tests, CT scans, MRI, etc.
Dental procedures and surgeries, such as cavity removal, root canal treatment, tooth extraction, etc.
Minor surgeries that do not require overnight observation
Chemotherapy, dialysis and other treatments for long-term diseases
Medicines
Rehabilitation

Let’s understand this with the help of an example.

Suppose Pooja developed a fever with a cold and went to a nearby clinic. The doctor diagnosed viral fever, prescribed some medicines to her and advised her to take rest. In this case, Pooja’s doctor consultation and medicine bills will be categorized as outpatient treatment and will be covered by her insurer under the OPD cover.

Difference Between Inpatient and Outpatient Hospitalization

Take a look at the main differences between inpatient and outpatient hospitalization in the following table:

Categories	Inpatient Hospitalization	Outpatient Hospitalization
Meaning	When a patient is admitted to a hospital (for at least 24 hours) for medical treatment	When a patient receives medical treatment from a health professional without getting admitted to a hospital
Medical Care	Requires long-term medical care, like complex surgery cases	Requires short-term medical care, like diagnostic tests
Monitoring and Observation	Requires constant monitoring and in-depth observation	Does not require constant monitoring and in-depth observation
Treatment Cost	Inpatient hospitalization costs are much higher than outpatient care	Outpatient treatment costs are way lower than inpatient hospitalization
Health Insurance Coverage	Covered if the hospital admission is for a minimum of 24 hours	Covered if the policy offers OPD benefit
Healthcare Professionals	Requires specialists and a group of medical professionals	Requires a general physician and medical specialists

Summing It Up

Inpatient and outpatient hospitalization are major ways of obtaining medical treatment. While one requires you to get admitted to a hospital, the other requires brief medical attention from a qualified health professional. Now that you are clear with the meaning of inpatient hospitalization and outpatient treatment, you know when to raise a health insurance claim with your insurance provider.

Do not forget to read your health policy terms and conditions carefully to know what you are covered for.