You are here:

Inpatient vs. Outpatient Care in Australia: What You Need to Know

Inpatient care involves treatment where a patient stays in a hospital overnight or longer, typically for serious conditions or surgeries. Outpatient care covers medical services provided without a hospital stay, such as consultations and minor procedures. Knowing which type of care you need helps you make informed decisions, plan for costs, and navigate insurance coverage.
Fact Checked

Updated: 21 June 2024

Understanding inpatient and outpatient care is crucial for your healthcare journey. Knowing when each type is appropriate helps you make informed decisions. You’ll ensure the best care for your needs by learning the specifics. Let’s explore these care types to empower your healthcare choices.

Key facts

Compare Health Insurance Quotes

Protect what’s most important to you. It’s easy, convenient and free!

By clicking ‘Request Your Quotes’, you agree and accept our Privacy Policy and Terms of Use and consenting to us contacting you about the products and services provided.

Understanding Inpatient Care

Inpatient care is required when a patient’s condition requires extended medical attention that can only be provided in a hospital setting. This type of care typically involves staying in a hospital for one night or more. 

Admission as an inpatient is based on criteria that include the severity of the condition, the need for complex and ongoing medical procedures, and the necessity for close monitoring that cannot be adequately provided on an outpatient basis.

The Inpatient Experience

Scenarios that typically require inpatient care include major surgeries, childbirth, severe illnesses, or extensive injuries where close medical supervision is essential. In these situations, patients are admitted to the hospital to ensure they receive comprehensive and continuous medical oversight. 

The inpatient setting provides a controlled environment where patient progress can be closely monitored, and immediate medical intervention is available if the patient’s condition changes

Inpatient Services and Treatments

Inpatient care encompasses a wide range of medical services and treatments designed to address significant health issues that require immediate and intensive care. Common services and treatments provided to inpatients include:

Costs for Inpatient Care

Due to its intensive and comprehensive nature, inpatient care typically incurs higher costs than outpatient services. These costs typically include room charges, surgical fees, medication costs, the use of high-tech medical equipment, and round-the-clock care from medical professionals. 

In Australia, private health insurance policies and Medicare work together to provide coverage options for inpatient care. Medicare, the public health system, offers coverage for many inpatient services in public hospitals, covering costs related to the hospital stay, including tests and surgeries performed by doctors who bill under Medicare. However, there may be limitations depending on the treatment and hospital choice.

Private health insurance can supplement Medicare by covering additional costs, such as private hospital fees, choice of doctor, and potentially quicker access to elective surgeries. Policyholders with private insurance often have a range of coverage options depending on their chosen level of insurance. These can include:

Patients considering inpatient care should review their health insurance policies and discuss with their providers to fully understand what is covered and any potential out-of-pocket costs. This preparation ensures that individuals can make informed decisions about their care and manage financial expectations effectively.

Understanding Outpatient Care

Outpatient care refers to medical services that do not require an overnight stay in a hospital. This type of care is designed for less severe medical issues that can be treated without extensive hospital support systems. 

Outpatient care includes consultations and check-ups and covers a broad spectrum of services and treatments that are crucial for patient care yet do not require prolonged hospital admission.

Common Situations Leading to Outpatient Care

This care model emphasises efficiency and convenience, allowing patients to return home the same day of their treatment. Outpatient care is typically utilised for:

Outpatient Services and Treatments

Typical outpatient services include:

These services are crucial for ongoing health management and are designed to be as accessible and convenient as possible for the patient.

Billing and Insurance Aspects

Billing for outpatient care is typically straightforward, with many services billed directly to the patient or through their health insurance provider. The costs for outpatient care are generally lower than inpatient care due to the lack of overnight stays and the reduced use of hospital resources. 

Patients should review their insurance policies to understand what outpatient services are covered and to what extent. It’s also wise to confirm coverage details with healthcare providers before outpatient treatment to ensure all costs are understood and manageable.

Key Differences Between Inpatient and Outpatient Care

Aspect
Inpatient Care
Outpatient Care
Length of Stay
Overnight or longer, depending on the condition severity
No overnight stay; treatment completed in one visit
Type of Care
Comprehensive for serious conditions requiring close monitoring
Less comprehensive, suitable for routine or minor conditions
Cost Differences
Generally more expensive due to extended hospital services
Less costly due to the absence of overnight stays and reduced resource use
Insurance Coverage
Typically broader coverage, but may involve higher out-of-pocket expenses for non-covered services
Often covered, but may have limitations on certain procedures or frequency of visits

Insurance Coverage in Australia

In Australia, both Medicare and private health insurance