What is the difference between outpatient and inpatient treatment?

Key Differences and Definitions

The difference between inpatient and outpatient services is that inpatient care involves being admitted to the hospital for treatment, typically requiring an overnight stay. On the other hand, outpatient care means you receive treatment without being admitted to the hospital, often just by attending procedures or appointments when you don’t stay overnight or occupy a bed for the day. Depending on the condition being treated, these appointments can range from one to multiple sessions.

Knowing the difference between inpatient and outpatient care is especially important when looking for private medical treatment covered by health insurance. This also helps to choose the right health insurance plan for you.

What is outpatient care?

Ambulatory care, also known as outpatient care, refers to medical services provided without requiring overnight hospitalisation or occupying a bed. It includes:

• Routine checkups
• Initial consultations
• Diagnostic tests and procedures

Following your tests or scans, any necessary follow-up treatments may be done on an outpatient, day-patient or inpatient basis.

What is inpatient care?

Inpatient care means you stay in a hospital overnight for treatment under close supervision. Whether it’s for:

• Surgery
• A serious illness
• Complex medical condition

During this time, you receive around-the-clock medical care, including pain management, monitoring for complications, and physical therapy to aid in your effective recovery.

What is day patient care?

As a day patient, you visit the hospital or medical centre for treatment during the day and return home without staying overnight.

Examples include

• Minor surgeries
• Dental surgeries
• Cataract surgeries
• Mole removal
• Mental health
• Minor orthopaedic procedures
• Certain types of biopsies
• Certain types of chemotherapy
• Dialysis sessions
• Other types of care

These procedures typically do not require at least one night stay and allow you to recover at home while still receiving necessary medical care.

Practical Examples of Inpatient, Day Patient and Outpatient Care

Here are some practical examples to illustrate the differences between inpatient, day patient, and outpatient care for heart surgery:

Does health insurance cover outpatient care?

When you’re thinking about health insurance, it’s important to know if it covers outpatient care. Outpatient care is when you go to the hospital or clinic for appointments, tests or treatments but need to stay overnight.

When your health insurance includes outpatient cover, it means it helps pay for things like doctor visits, diagnostic tests (like X-rays or MRIs) and treatments you get without staying in the hospital.

Levels of Outpatient Cover

When you’re choosing a health insurance plan, it’s essential to consider how often you may need to see a specialist or undergo tests, and choose a plan that offers enough outpatient cover to meet those needs.

No Outpatient Cover

Some health insurance plans let you choose not to have outpatient cover at all. This might make your monthly payments lower. But it means you’d have to pay for appointments, tests, and treatments yourself unless they’re for a specific condition your policy covers.

Standard Outpatient Cover

With standard outpatient cover, you usually get up to three consultations annually or a maximum of £750 for outpatient treatments. Some insurers like Vitality Health, Aviva, and The Exeter let you choose full diagnostics, meaning the cost of tests and scans won’t eat into your yearly limit. And if you go with AXA Health, their standard outpatient plan gives you unlimited diagnostics automatically.

Full Outpatient Cover

Full outpatient coverage in health insurance means you’re fully covered for all medical services and treatments that you receive outside of the hospital, like doctor’s visits, tests, and treatments. There are usually no limits on the number of visits or treatments you can have, so you can get the care you require without worrying about running out of coverage. It’s like having a safety net for all your outpatient medical needs.

Do I need outpatient cover on private health insurance?

Full outpatient cover is not included as standard in private health insurance plans in the UK. However, insurers offer various options for outpatient care, typically ranging from £500, £750, £1000 and unlimited. Deciding whether you need outpatient cover depends on your individual healthcare needs and financial circumstances. If you frequently require consultations, diagnostic tests or minor treatments outside of hospitals, opting for outpatient cover can provide peace of mind and ensure you’re covered for these services.

On the other hand, if you anticipate primarily needing inpatient treatments or prefer to lower your premiums, you may opt for a policy without outpatient cover. Consider factors such as your medical history, potential future healthcare needs, and budget constraints when choosing the level of outpatient cover that best suits you.

How much does a policy cost with and without outpatient cover?

The cost of a private health insurance policy varies depending on several factors, including the level of coverage, your age, postcode, medical history and whether outpatient cover is included. 

Policies that include outpatient cover typically have higher premiums compared to those without it. For example, a policy with full outpatient cover might cost more than one with limited or no outpatient cover.

Here are the illustration monthly premiums for Vitality Health policies with no inpatient, limited, and full outpatient cover. These prices are based on:

• A healthy 40-year-old individual 
• Non-smoker
• London postcode
• Moratorium underwriting
• Consultant Select hospital list
• £100 Excess per year

How Can We Help You?

At Premier PMI, we’ve been assisting people with their healthcare insurance plans for over 40 years. We understand that choosing the right policy can be tough, which is why our team is dedicated to giving you personalised guidance. We’re not just brokers; we’re partners in your health journey, every step of the way. We aim to make sure you have timely access to top-notch specialists when you need care the most. Plus, using our services could save you up to 38%. Whether it’s private health insurance for you, your family or any other health insurance plan, we’re here to help. Reach out today for a customised quote. Experience why so many families trust the caring team at Premier PMI to safeguard their well-being.

Stuart Hendy, Senior PMI Advisor &Editor

Stuart Hendy is a highly experienced health insurance broker with extensive knowledge of private medical insurance and private treatment. His expertise is frequently sought by industry professionals and his insights have been featured in leading financial publications. Stuart is committed to providing his clients with the best possible healthcare solutions and empowering them to make informed decisions.

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