Whether you are receiving care through the NHS or from a private practitioner, all kinds of medical treatments can be classified as inpatient or outpatient. No matter your medical situation, it is important to be clear on the distinction.
This is especially true when seeking private treatment under health insurance coverage. Knowing the difference will help you choose the right insurance plan and get satisfied with the provided services like 53% of UK citizens do.
What is outpatient care?
Outpatient care, also known as ambulatory care, is any treatment or service that does not require hospitalisation. For example, annual check-ups, clinic appointments, and tests and scans all qualify as outpatient care.
Follow-up treatments may be issued after scans or tests. These treatments may themselves be forms of outpatient or inpatient care.
Does health insurance cover outpatient care?
Most standard health insurance policies only cover inpatient care. However, you can add outpatient care to your policy for an additional cost.
Some health insurance policies include outpatient care but may have limits applied to them. This means you will only be covered up to a particular amount annually. If your outpatient care costs exceed this amount, you will either have to use the NHS or pay for additional outpatient care out of your own pocket.
What is inpatient care?
Any services or treatments that require you to stay in hospital overnight are considered inpatient care—for example, major surgery, childbirth, and rehabilitative treatment. You may be an inpatient due to an accident or acute episode of an illness or chronic health issue that requires hospitalisation.
Does health insurance cover inpatient care?
Standard health insurance policies do cover inpatient services and care. Inpatient care costs pay for everything from staff fees and treatment costs to catering and hospital amenities. They also cover preliminary tests and medical care costs, covering the price of the supplies needed.
Differences between inpatient and outpatient care
Inpatient care is when a patient must stay in hospital overnight for treatment. Outpatient care, on the other hand, is when a patient receives treatments and services without requiring hospitalisation. It is important to consider the differences between these two types of care.
Inpatient CareOutpatient Care
| Patient is admitted to hospital for at least 24 hours for treatment. | Patient is not required to stay in hospital for treatment. |
| Complex or major surgeries. | Minor surgeries, cosmetic surgeries, etc. |
| Treatment of traumatic injuries. | Same-day emergency service. |
| Specialist treatments and observation. | Specialist consultancies, bloodwork, diagnostic tests. |
Comparing inpatient and outpatient services
Outpatients are patients who are treated without being admitted to a hospital. They may receive treatment within the hospital, but they are not considered inpatients unless admitted for at least 24 hours. Outpatients are free to leave the medical facility and go home without supervision.
Inpatients are required to be treated in hospital, however. These patients require more intensive care and, in the case of conditions such as cancer, often specialist treatment. During their stay, inpatients are supervised by the hospital staff.
Costs
When thinking about a health insurance policy, it is important to consider the cost of the insurance premium. This will depend on the services you have included in your plan.
The cost of outpatient and inpatient treatments varies greatly. Outpatient care is far cheaper, as it involves only the cost of any tests taken, staff fees, and potentially medication costs.
Inpatient care is more expensive. This is because inpatient treatment costs include facility-based charges on top of medical fees. As well as paying for staff and treatment, inpatient care costs also pay for your hospital room, bathroom, and the food you eat during your stay. Administrative costs are also included in inpatient care.
Coverage
Depending on the health insurance plan you have chosen, you will be covered for either both inpatient and outpatient treatment or just inpatient treatment on its own. Your health plan will cover you according to the agreements of your policy.
Some outpatient treatments may be covered as part of preventive care. Procedures such as routine colonoscopies or mammograms fall under this umbrella. The following will explain exactly how your health insurance plan will cover your treatments and services:
- Until you meet your plan excess, you will pay for treatments and services.
- Once the excess has been met, your insurance plan will come into effect. You will share the care costs with your plan. For example, you might pay 30% of your care costs, with your insurance plan covering the remaining 70%. However, it differs from provider to provider.
- Your plan has an annual out-of-pocket maximum. This figure is the maximum you are required to pay yourself towards your own medical cost. If you hit this upper limit, your health insurance will cover 100% of your treatment costs.
- Knowing and understanding the differences between outpatient and inpatient care will help you compare health insurance policies. It will also help you to better anticipate future costs for any outpatient or inpatient treatment you might receive.
Physicians
While most physicians can provide both inpatient and outpatient care, specialists usually provide the former while primary care physicians deal with outpatient treatment.
For instance, your general practitioner will provide you with outpatient treatment for ongoing conditions and work with specialists on inpatient treatment.
Psychiatrists are another example of healthcare practitioners working in both inpatient and outpatient care. They may help treat hospitalised patients or see clients or regular appointments outside of the hospital environment.
How are inpatient and outpatient services similar?
Inpatient and outpatient services are in many ways quite similar. Indeed, there are several areas in which these two patient care settings intersect.
Many treatments are not entirely exclusive to inpatient or outpatient treatment. For example, while major surgery tends to be a job for inpatient care, people are often admitted into hospital for minor surgeries on an outpatient basis.
Furthermore, with both inpatient and outpatient care, many patients will take similar tests and scans to help find them a proper diagnosis.
What determines if you need inpatient or outpatient care?
Doctors determine whether you require inpatient or outpatient care depending on the type of treatment and support you need. If you require major surgery, intensive 24/7 care, or treatment for a severe illness, then you will most likely be admitted into the hospital for inpatient treatment.
Minor surgeries, tests and screenings, and many other treatments and procedures do not require you to stay in the hospital, however. For these types of treatments, you would only need outpatient care.
Why would a patient need inpatient treatments rather than outpatient?
A patient would need inpatient treatment rather than outpatient if they were in a particularly critical condition, requiring full-time care and support.
Patients might be admitted to the hospital for inpatient care if they have suffered severe burns or other traumatic injuries or are suffering from a serious illness and need a greater degree of care. They also may be admitted to treat chronic diseases that require special care or if they have a serious mental illness.
Is inpatient and outpatient cover included in any provider’s policies?
Inpatient and outpatient cover are both included in several providers’ policies in the UK.
Bupa offers two different kinds of private health insurance. Both include complete inpatient cover, providing the treatment is eligible under your insurance, and the treatment is from a Bupa-approved facility. Their unlimited comprehensive health insurance cover also includes outpatient treatment.
Aviva also offers cover for outpatient treatment. Their insurance covers this by default and includes diagnostic testing, specialist treatments, and specialist consultations. However, it does not include pregnancy or childbirth, chronic conditions (not including cancer treatment), or pre-existing conditions.
Do I need outpatient cover on private health insurance?
Ultimately, whether or not you need outpatient cover on private health insurance is up to you. There are several points to consider when trying to decide.
Adding an outpatient cover to your health insurance will increase the price of your premium. However, the alternative comes at a price. Not only will you have to wait for diagnostic scans and tests, but you will have to wait for an official diagnosis from the NHS before pursuing private inpatient treatment.
While the cheaper option, not having outpatient cover could result in significant delays to private inpatient care.
Final words
This article has explained the difference between inpatient and outpatient treatment. The former is the care a patient receives while staying in hospital overnight. Such patients require intensive care or specialist treatment. Outpatient treatment is when a person receives care without being admitted to the hospital.
While health insurance policies do not usually include outpatient treatments, as standard practice, adding an outpatient cover to private health insurance is well worth consideration. This article has outlined the benefits and negatives of adding outpatient cover and discussed what such insurance would include.