When a patient needs medical care, the approach could fall into two major categories: inpatient care and outpatient care. With inpatient care, a person is admitted to the hospital to stay overnight. With outpatient care, a patient goes home following a treatment or procedure.
In the not-so-distant past, complex surgeries were performed primarily in a hospital setting. But today, thanks to minimally invasive technologies and new anesthesia and pain control methods that allow for a faster recovery, outpatient care is an option in more and more circumstances.
You should always talk to your doctor before deciding whether inpatient care or outpatient care is right for you. But to better understand the differences, read the guide below to inpatient care vs. outpatient care.
What is inpatient care?
When a patient needs to be admitted to a hospital or another type of health care facility, such as a rehabilitation facility, mental health center, or addiction treatment center to receive care, they receive what’s known as inpatient care. This determination is made by the patient’s health care provider and may influence the type of therapies and treatments the patient receives, and the manner in which insurance covers the services received.
What is outpatient care?
When a patient undergoes a procedure or treatment and a health care provider doesn’t admit him or her to a hospital or other type of health care facility for an overnight stay, it’s considered outpatient care—otherwise known as ambulatory care. Outpatient care can apply to a number of scenarios, including in-home visits by medical professionals, visits to the emergency room, routine wellness appointments, surgeries, cancer treatments, dialysis, lab tests, and more. The manner in which insurance covers outpatient care differs from inpatient care.
Is there ever any overlap between inpatient care vs. outpatient care?
While the distinction seems simple, in some cases, inpatient vs. outpatient care can get confusing. Let’s say a patient stays in the hospital overnight for any number of reasons—testing, monitoring, recovery, etc. That doesn’t automatically mean the patient received inpatient care. Inpatient care only applies when a health care provider writes an order to admit a patient. In absence of that, the category of care is still outpatient care, even if it involved an overnight stay.
What are some of the benefits of inpatient care?
For serious illnesses and injuries and for certain complex surgeries, inpatient care can be beneficial. The patient will be under observation of the health care staff, who can provide the necessary medications and pain relief as needed, respond to any changes or complications, while also providing meals and assisting in personal care.
In addition, services such as imaging and laboratory tests are on-site, and therapists—whether respiratory, occupational, or physical—can visit and start working with the patient right away.
What are some of the benefits of outpatient care?
For certain health services and procedures, outpatient care offers a number of benefits over inpatient surgery, care, and recovery. In a hospital setting, the timing of surgeries, even when previously scheduled, can sometimes be unpredictable, because emergencies may occur and cause delays.
But in an outpatient setting, such as a doctor’s office or surgery center, procedures tend to be less complex, allowing for scheduling that can be more predictable and convenient. In addition, outpatient care may be less stressful than inpatient scenarios, because a patient can recover in the comfort of his or her own home.
What are some examples of inpatient care?
A number of different scenarios could require inpatient care. Here are some examples:
- Complex surgeries
- Serious illnesses or medical issues
- Addiction treatment
- Psychiatric treatment
- Physical rehabilitation
What are some examples of outpatient care?
Outpatient care covers a number of different treatments and services. Here are some examples:
- Wellness and prevention care, including routine physicals
- Clinic visits
- Diagnostic tests, such as lab work, X-rays, ultrasound imaging, and MRI scans
- Certain procedures and surgeries, such as tonsillectomies, hernia repairs, gallbladder removals, some cosmetic surgeries cataract surgeries, spinal/lumbar surgeries, hysterectomies, and angioplasty
- Treatments, such as chemotherapy and dialysis
- Addiction treatment
- Physical rehabilitation
- Emergency room visits
What are the potential price differences in inpatient vs. outpatient care?
Inpatient care may be more expensive than outpatient care. According to a 2018 study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, the average inpatient stay in the United States in 2016 cost more than $22,000, while the average outpatient visit cost nearly $500. Of course, that’s a wide range of dollars that covers an expansive range of services and procedures.
For a better understanding of cost differences, it’s best to look to studies that show case-by-case comparisons. For example, according to a study published in the Orthopaedic Journal of Sports Medicine the outpatient cost of a particular surgical procedure, called unicompartmental knee arthroplasty was $20,500 less than the average inpatient charge of $46,854.
In another study, Blue Cross Blue Shield found that for adults under the age of 65 who underwent outpatient knee replacement, the cost for outpatient surgery was $19,002, compared with $30,249 for inpatient. For those who had hip replacements, the cost was $22,078 for outpatient compared with $30,685 for inpatient. Further, the report indicates that complication rates in outpatient settings are actually lower than complication rates in inpatient settings for these two procedures.
How can you decide if inpatient vs. outpatient care is right for you?
In many cases, a doctor makes the decision on whether or not a person should receive inpatient vs. outpatient care. But in some cases, patients are given a choice.
Of course, every decision should be made on an individual basis, and should examine issues of cost, stress, convenience, and safety. These are important conversations to have with a primary care provider to ensure that the best decision is made for your unique circumstance.