Inpatient vs. Outpatient Care: Which One Is Right for You?

When you’re struggling with a medical condition, one of the most important decisions you will make is whether to receive inpatient or outpatient care. This post will teach you the difference between inpatient and outpatient care and who can provide each type of care. We will also look at how much it costs to receive inpatient vs. outpatient treatment and whether insurance covers it.

Key Points

  • What Is Inpatient Care?
  • What Is Outpatient Care?
  • What Determines the Type of Care?
  • Inpatient vs. Outpatient Surgery
  • Who Can Provide Which Type of Care?
  • How Much Does Inpatient vs. Outpatient Care Cost?
  • What Is the Difference Between Inpatient and Outpatient Coding?

What Is Inpatient Care?

Inpatient care is a type of medical treatment in which the patient resides in a hospital or other medical facility while receiving care. Inpatient hospital care is often more intensive than outpatient care, as patients are under the constant supervision of medical staff.

Types of Inpatient Services

Per the inpatient treatment definition, this type of care is typically used for more serious conditions requiring around-the-clock monitoring. Still, it can also be used for less severe conditions that need monitoring. Here are the primary inpatient service examples:

  • Acute care services: These are short-term medical services for people who have a sudden illness or injury and need immediate treatment. Examples of acute care services include emergency room visits, surgery, and hospital stays for acute diseases.
  • Inpatient rehabilitation services: These are services provided to people who need more intensive therapy and medical care than can be provided at home or in outpatient clinics. Inpatient rehabilitation services are typically offered in a hospital or specialized rehabilitation facility. Some examples of inpatient rehabilitation include inpatient mental health treatment, physical therapy, occupational therapy, and speech therapy.
  • Hospice care: This is end-of-life care that focuses on providing comfort and support to terminally ill people. Hospice includes pain management, emotional support, and spiritual counseling.
  • Long-term care: This inpatient care is typically provided to people with chronic illnesses or disabilities. Long-term care includes help with activities of daily living, such as bathing and dressing, and nursing care.

What Is Outpatient Care?

Unlike inpatient treatment, a patient doesn’t have to be admitted to the hospital. Instead, they receive ambulatory care—they visit a hospital, an outpatient clinic, or an outpatient center for treatment but don’t stay overnight.

Outpatient Treatment Examples

Outpatient care is typically used for less severe conditions. In some cases, patients will have to stay overnight in a medical facility for observation after receiving outpatient care. These services can be provided in a hospital or clinic and in the patient’s home or community. These are some of the types of outpatient services:

  • Physical therapy
  • Doctor’s appointments
  • Diagnostic tests
  • Surgery
  • Imaging services
  • Rehab
  • Therapy/Counseling
  • Nutrition/Wellness counseling
  • Chronic disease management
  • Immunizations
  • Health education classes
  • Support groups
  • Hospice

What Determines the Type of Care?

Outpatient vs. inpatient? These factors determine what type of care a patient will receive:

  • The type of treatment required
  • The patient’s age
  • The patient’s overall health
  • A history of substance abuse

Can You Choose the Type of Care with Certain Services?

Even though a doctor usually prescribes or advises the type of care, you may be able to choose it yourself in some cases. These are the most common occurrences:

Physical Therapy

If you need physical therapy, you may be able to receive outpatient care at a clinic or your home or inpatient care at a hospital.

Addiction Treatments

These can also be done in outpatient or inpatient settings, depending on the patient’s needs. But what’s the difference between inpatient vs. outpatient rehab? Less serious addictions can be treated in an outpatient setting, while more severe addictions will require inpatient treatment. Keep this in mind: doctors suggest that the combination of inpatient and outpatient drug rehab for at least 90 days is most likely to lead to success.

If you’re looking for inpatient vs. outpatient rehab success rates, the research confirmed that 50% of patients relapsed within 90 days after inpatient treatment, while a 2021 telemedicine treatment led to a 32.84% reduction in opioid use.

Mental Health Therapy

Mental health therapy and treatment for eating disorders can be done in both outpatient and inpatient settings. Inpatient treatment (psychiatric hospital) is typically reserved for patients with more severe mental health conditions, such as schizophrenia or bipolar disorder. On the other hand, outpatient mental health care is recommended for less extreme conditions.

Inpatient vs. Outpatient Surgery

There are advantages and drawbacks to both inpatient and outpatient surgery. Inpatient surgery often requires a longer recovery time, as the patient must stay in the hospital for several days after the surgery. This can be expensive, as insurance often doesn’t cover inpatient hospital stays. In addition, there is a greater risk of infection when staying in the hospital.

Examples of inpatient surgery include:

  • Hip replacement
  • Knee replacement
  • Open heart surgery
  • Cesarean section
  • Spine fusion

Outpatient surgery is often less expensive, as there is no need for an overnight hospital stay. In addition, outpatient surgery usually has a shorter recovery time, as the patient can go home from the outpatient clinic the same day. However, there is a greater risk of complications when having outpatient surgery, as the patient is not being monitored as closely.

Examples of outpatient surgery include:

  • Appendectomy
  • Gallbladder removal
  • Hernia repair
  • Tonsillectomy
  • Some cataract surgeries

Who Can Provide Which Type of Care?

As we’ve learned, inpatient care can be provided at a hospital, nursing home, or rehabilitation center. In some cases, patients may receive inpatient care at their home if they have a home health nurse. For a patient to receive inpatient care, a doctor must request it. Generally, specialists are more likely to provide inpatient treatments, but physicians can do it.

Outpatient care is typically provided at a hospital, outpatient clinic, or doctor’s office, but patients can also receive some outpatient services at home. Though physicians mainly administer and supervise outpatient treatments, they often consult with specialists.

As for inpatient vs. outpatient mental health treatment, psychiatrists are equally specialized.

How Much Does Inpatient vs. Outpatient Care Cost?

Inpatient vs. outpatient costs differ depending on the severity of the condition and the type of facility where the patient receives care. The cost of inpatient care is typically higher than outpatient care. The national average daily cost of inpatient care is $1,831 in government hospitals. Outpatient care can range from $100 to $500 per day.

How Does Insurance Cover Inpatient vs. Outpatient Care?

Most insurance plans will cover both inpatient and outpatient care. Patients may need to pay a higher deductible for inpatient care in some cases. In other cases, patients may need to get a referral from their doctor before receiving outpatient care.

What Is the Difference Between Inpatient and Outpatient Coding?

Patient coding refers to a diagnosis report. Inpatient coding refers to the codes used for reporting the diagnosis and services provided during a patient’s stay. Outpatient coding is used when a patient receives care at an outpatient clinic, doctor’s office, or another medical facility and refers to the report from that one visit.

Inpatient vs. Outpatient Care—Key Takeaways

  • Inpatient care is more intensive and usually costs more, but it may be necessary if you have a severe condition.
  • Outpatient care is less intensive and usually costs less, but it may not suit all situations.
  • You should discuss with your doctor which type of care is right for you.
  • Insurance typically covers inpatient and outpatient care, but there may be some restrictions.