Inpatient vs. Outpatient Care: How to Choose the Right Path for Treatment

What is outpatient care?

Outpatient care,⁶ also called ambulatory care,⁷ involves medical services that do not require a hospital stay. These include checkups, consultations, diagnostic tests such as CT scans, MRIs, x-rays, mammograms, and lab tests, as well as minor surgeries, colonoscopy, and outpatient mental health treatment.

Outpatient services are typically less intensive and more cost-effective than inpatient options. They can be provided in a variety of settings including doctor’s offices, community health clinics, and outpatient programs within larger healthcare systems. Outpatient care is especially beneficial for individuals who have a stable support system at home and don’t require 24/7 medical supervision.

What are some examples of outpatient care?

Examples of outpatient services include:

• Routine checkups and screenings
• Outpatient surgery like hernia repair or cataract removal
• Lab tests, x-rays, and MRIs
• Therapy sessions and mental health treatment
• Follow-up visits after hospitalization
• Treatment programs for mild substance abuse issues
• Follow-up care after acute psychiatric condition⁸

These services help manage health issues without requiring patients to stay in a hospital overnight.

What determines if you need inpatient vs. outpatient care?

St. George’s University School of Medicine shares that there may be a “gray area” when it comes to determining if inpatient or outpatient care is needed,⁹ but treatment and other medical providers can help.

“While there’s a clear difference between an inpatient and an outpatient, there is a little bit of gray area as well. Occasionally, physicians will assign a patient observation status while they determine whether hospitalization is required. This period typically lasts for no more than 24 hours.”

Several factors influence whether a patient needs inpatient or outpatient care:

• Severity of the condition: Life-threatening or complex conditions often require inpatient care.
• Type of treatment: Procedures that require intensive monitoring or specialized support usually involve hospitalization.
• Mental health needs: Acute mental health disorders or crises may necessitate inpatient stabilization.
• Recovery and support: Those without a safe home environment may benefit from the structured setting of an inpatient facility.
• Recommendations from healthcare providers: Ultimately, medical professionals will assess and recommend the best type of care based on your specific needs.

What are the costs for outpatient vs. inpatient?

In general, inpatient care is significantly more expensive than outpatient care due to the costs associated with a hospital stay, including meals, facility use, and continuous medical supervision. Outpatient treatment¹⁰ is usually more affordable, especially for routine or preventive care. That said, the total cost of either option depends on:

• Type of treatment or procedure
• Length of hospital stay
• Facility and provider fees
• Diagnostic or imaging services (e.g., CT scans, mammograms)
• Insurance coverage and co-pays

Do you have coverage for inpatient vs. outpatient health care?

Most health insurance plans provide some level of coverage for both inpatient and outpatient care, but the details can vary. It’s important to:

• Check your plan’s insurance coverage for both inpatient programs and outpatient programs
• Understand your deductible, co-pay, and out-of-pocket maximums
• Get pre-authorization when required, especially for inpatient treatment

Many insurance providers categorize care based on medical necessity and type of treatment, so having a clear diagnosis and documented provider recommendation is essential. Some plans offer more generous coverage for preventive health services, like screenings and wellness checkups, which are typically done on an outpatient basis.

Understanding the difference between inpatient and outpatient care is crucial for making the right treatment decisions.

Each offers distinct benefits, and your choice should be guided by the severity of your health condition, the type of care required, and guidance from trusted healthcare providers. There may also be situations or conditions that benefit from an inpatient to outpatient transition.¹¹

Whether you’re facing a medical emergency, managing chronic illness, or navigating mental health challenges, knowing your options can help you choose the right path to recovery.

FAQs

Q: What’s the difference between inpatient and outpatient?

A: Inpatient care requires a patient to stay overnight in a hospital or treatment facility, often for serious conditions needing close monitoring. Outpatient care involves treatment or services—like consultations, tests, or minor procedures—without an overnight stay.

Q: What is an example of an inpatient setting?

A: Inpatient settings include hospitals, psychiatric units, residential treatment centers, and rehabilitation facilities where patients are admitted for round-the-clock medical supervision.

Q: What counts as an outpatient?

A: An outpatient is a patient who receives medical care—such as a checkup, diagnostic imaging, or therapy session—without being admitted to a hospital or staying overnight.

Q: How many hours is considered inpatient?

A: While there’s no strict hourly definition, a patient is typically considered inpatient once they are formally admitted to the hospital and stay for at least one night under medical supervision.

Q: What is outpatient care?

A: Outpatient care refers to medical services that don’t require a hospital stay. It includes doctor visits, lab tests, outpatient surgeries, and mental health therapy.

Q: What are some examples of inpatient care?

A: Examples include emergency surgery, treatment for heart attacks, psychiatric hospitalization, and inpatient substance use rehab programs.

Q: What is Outpatient Mental Health Care?

A: Outpatient mental health care involves therapy, counseling, medication management, or group programs where patients return home after each session.

Q: When does someone need inpatient mental health care?

A: Inpatient mental health care is necessary when a person is in crisis, at risk of harming themselves or others, or needs intensive treatment and supervision not possible at home.

Q: Do you need inpatient or outpatient mental health treatments?

A: It depends on symptom severity, safety risks, support systems, and provider recommendations. Many start with outpatient care and may transition to inpatient if symptoms escalate.

Q: Is there a difference between inpatient vs outpatient surgery?

A: Yes. Inpatient surgery requires hospitalization for monitoring and recovery, while outpatient surgery (also called same-day surgery) allows patients to return home post-procedure.

Q: How do costs compare between inpatient and outpatient care?

A: Inpatient care is generally more expensive due to hospital stays, staffing, and intensive services. Outpatient care is usually more affordable and cost-effective for routine treatments.

Q: What are the benefits of outpatient treatment compared to inpatient care?

A: Outpatient treatment allows for greater flexibility, lower cost, continued daily life activities, and is ideal for stable conditions not requiring 24/7 monitoring.

Q: What factors determine whether a procedure is inpatient or outpatient?

A: Key factors include the complexity of the procedure, patient health status, need for anesthesia or monitoring, provider recommendations, and insurance policies.