Private health and protection insurance expert and editor
When you need medical care, your doctors will advise you on the treatment you need and whether you'll receive it as an inpatient or outpatient. What does that mean for you? In this post, we'll share the main differences between inpatient and outpatient care to help you prepare.
The main difference between inpatient and outpatient treatment is in the way you attend for care. As an inpatient, you can expect to stay in the hospital overnight. Outpatient treatment is delivered in a series of appointments where you can go home in between. We'll explain more in the following sections.
When you're treated as an inpatient, you'll need to stay overnight in a hospital while you receive treatment.
That could be because you've had major surgery and must be closely monitored to ensure you're recovering well. You may also need rehabilitation treatment such as physiotherapy to get you back on your feet.
In some cases, good patient care means that the hospital needs to check you have appropriate follow-up support to help you with daily tasks before you can go home.
You could also need inpatient treatment because there are different elements involved in your care, and it's more efficient for you to have a hospital stay so that you can receive coordinated medical treatment from a range of specialists.
You may also receive day patient care if appropriate.
Day-patient care is somewhere between inpatient and outpatient care. It's possible to have surgery as a day case. These are typically lower-risk operations where you need to have some time staying in the hospital but will usually be able to go home on the same day.
Cancer treatment is also sometimes delivered in a day unit, particularly chemotherapy, where you may need to stay in the hospital for several hours.
While these treatments need inpatient care, you're also likely to need outpatient care as well. This could be before inpatient treatment or afterwards to monitor your progress.
Outpatient care (sometimes called ambulatory care) is provided when you don't need to stay overnight in a hospital to receive treatment. Instead, you'll be able to go to the hospital for your outpatient appointment and then go home afterwards.
Outpatient care can be offered for less severe conditions that still need regular treatment over a period of time without hospital admission. This could include musculoskeletal conditions that can be improved with regular physiotherapy.
You might also be treated as an outpatient for more serious chronic conditions that need to be monitored, for example, diabetes, asthma, cystic fibrosis or angina.
You might also need outpatient care in the run-up to inpatient treatment to prepare you for surgery or to assess the type of treatment you might need.
You'll also likely be offered outpatient care after a stay in hospital to ensure that you're recovering well and to allow your doctors to plan any further treatment you might need.
Health insurance is designed to cover acute conditions that can be resolved with a course of treatment. All basic health insurance policies cover inpatient care needed for this type of condition, so you'll be covered if you need to stay overnight in the hospital.
Health insurance cover for private inpatient care will usually cover the following costs:
Depending on your health insurance plan, you may also be able to receive inpatient cancer treatment such as radiotherapy and chemotherapy as well as surgery. Some insurers will also cover the blood and other necessary diagnostic tests immediately before surgery. Cancer cover varies depending on your insurance plan, with some insurers including it as standard while others only offering it as an optional extra.
Some basic private health insurance policies include access to outpatient services after you've had inpatient treatment. Generally speaking, outpatient care is only covered if you opt to add it to your policy and pay an additional premium.
If your health insurance only covers inpatient care costs, you can have surgery or other inpatient treatment privately. Then you'll be discharged to the care of your general practitioner, who'll see you for check-ups and arrange for you to have follow-up treatment or rehabilitation via the NHS.
You'll need a more comprehensive private health insurance policy if you want to access private outpatient treatment. Alternatively, you can opt for a basic health insurance policy and add outpatient cover as an optional extra. This will allow you to access outpatient treatments without paying the higher premiums of a more comprehensive policy.
When you opt to have outpatient cover included in your policy, it's worth comparing the cover level. There's usually a limit on the amount of outpatient care your insurance plan will pay for. Cover limits are usually £500, £1,000, £1,500 or unlimited.
When insurers set their premiums, they assess the likelihood of someone claiming on the policy. This will include a variety of factors, some of which will relate to you as an individual and others which are more general. These factors mean that including outpatient cover is usually more expensive.
The chances of you needing inpatient care for a serious illness or major surgery are much lower than the possibility that you'll need physiotherapy or minor surgery. Most people will need minor diagnostic tests at some point in life; severe injuries are much rarer.
If you need care on an outpatient basis, it could also carry on for a more extended period, which means that the cost to your insurer will be higher and more difficult to predict.
Yes. Outpatient cover isn't usually included in health insurance policies as standard, so you can choose whether you want it. The combined cost of the premium for inpatient and outpatient cover is higher than the cost of private inpatient treatment alone.
Disclaimer: This information is general and what is best for you will depend on your personal circumstances. Please speak with a financial adviser or do your own research before making a decision.
Chris Steele is myTribe’s resident expert in private health insurance and healthcare, with over a decade of experience in the field. As a Chartered Insurance Institute (CII) qualified professional, he has helped countless consumers navigate private medical insurance. Regularly quoted by national media, Chris is a trusted voice in the UK insurance industry, with his insights featured in leading consumer finance publications.
An outpatient is someone who needs medical care but doesn't require hospitalization. Many patients need outpatient treatment when they have a less serious illness that still needs specialist treatment.
An outpatient usually attends a hospital or another medical facility for appointments but won't need to stay overnight. Instead, they'll receive medical care or a check-up and return home the same day.
The main difference between inpatient and outpatient services is that inpatient care typically needs at least one night in the hospital. An inpatient will often require surgery or intensive care along with monitoring by hospital staff which can only be done on an inpatient basis.
Some types of care can be given on an inpatient or outpatient basis. This can include treatments such as chemotherapy, where your medical team will assess your circumstances and best interests before making a recommendation.
However, the type of care you need will generally dictate whether you're treated as an inpatient or outpatient.
You'll be offered outpatient care if you don't need to stay in the hospital. This might be because you're still having tests and investigations.
Minor surgeries will usually be carried out as part of your outpatient care, but you may still need access to a hospital bed to rest and recover before you're discharged.
Rehabilitation usually requires regular appointments over several weeks, so you'd unlikely need (or want) to stay in the hospital between treatments.
You'll be offered inpatient care if it's essential to deliver your care. If you've had major surgery, you'll need monitoring afterwards, so staying in a hospital room will enable this.
You may be treated as an outpatient as a follow-up. NHS resources are stretched, so it's unlikely that a hospital stay will be recommended unless necessary.
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