OPD vs IPD: Know the Difference Between OPD and IPD Treatments

What is OPD?

OPD stands for the outpatient department. It is a medical facility where patients receive medical consultations, undergo tests, get diagnosed, and obtain treatment for minor illnesses/injuries at a hospital or clinic without getting hospitalized. Under OPD, patients are sent home after the doctor examines them, assesses their symptoms, and recommends treatments & medications on a day care basis.

Some common examples of OPD (Outpatient Department) services are:

• Visiting a doctor for the common cold
• Getting an X-ray and plaster for a fracture
• Vaccinations
• Routine health check-ups

What is IPD?

IPD stands for in-patient treatment. It is a medical facility where patients are admitted overnight at a hospital to obtain treatment or surgery for a major illness, disease or medical condition. Under IPD, patients are required to stay at the hospital for more than 24 hours amidst professional medical set-up under the observation of doctors, nurses and other medical professionals.

Some common examples of IPD (In-patient Department) services are:

• Major surgeries like open heart surgery, knee replacement surgery, etc.
• Childbirth, including natural and C-section surgery.
• Treatment of severe health conditions like heart attacks, pneumonia, low platelets after dengue fever, etc.

Difference Between OPD and IPD Treatment

While the OPD full form is outpatient department and the IPD full form is in-patient department, they are different in many other ways. Take a look at the following table to know the difference between OPD and IPD treatment:

Benefits of OPD Treatment

Take a look at the benefits of OPD treatments:

1. More Affordable

   OPD treatments are more affordable than IPD treatments as they do not require patients to stay overnight at the hospital, leading to minimal medical expenses.

2. Suitable for Minor Health Issues

   Minor health issues, like common cold, fever, etc., that do not require hospitalization can be managed on an OPD basis. Just a small visit to the doctor on an OPD basis can get the patient diagnosed and the doctor can suggest tests and medications.

3. Faster Treatment

   OPD treatments take less time as patients can make prior appointments, consult with the doctor, undergo tests and complete the treatment within a few hours.

4. More Convenient

   Obtaining treatments on an OPD basis is more convenient than an in-patient treatment as the patients can go home within a few hours. They need to visit the hospital or clinic only for consultation or treatment and can avoid the hassle of getting hospitalized.

5. More Accessible

   OPD treatments are more accessible for people as they are not very costly. Thus, people with limited financial resources or no mediclaim policy can also afford outpatient treatment.

Benefits of IPD Treatment

Check out the benefits of IPD treatments:

1. Suitable for Major Surgeries

   In-patient treatments are ideal for patients who need to undergo major surgeries or procedures, like heart surgery or childbirth, as they need to stay at the hospital for an extended period. This is because such patients need continuous monitoring to avoid developing any complications and ensure full recovery before being discharged.

2. Ensures Intensive Medicare

   IPD treatments ensure intensive medical care to patients from doctors, nurses and other medical professionals to minimize the chances of any complications after the surgery. They monitor the patients' conditions continuously and provide immediate medical care if any complications arise.

3. Continuous Monitoring

   Patients undergoing major surgeries and complicated procedures can benefit from IPD treatment as medical professionals can continuously monitor their health during their stay at the hospital.

4. Health Insurance Coverage

   Almost all health insurance plans cover the cost of IPD treatment, allowing patients to afford to stay at the hospital as long as their health demands.

When to Choose OPD and IPD Treatment?

Deciding when to go for an OPD and IPD treatment can get a little confusing. Here is when to choose an OPD and IPD treatment:

Choose OPD Treatments:

• Minor Health Issues - To obtain treatments for minor health issues, like fever, lower back pain, cough, etc., that require doctor consultations, diagnostic tests and medications without the need for staying overnight.
• Minor Procedures - To undergo minor procedures, like getting a plaster, stitching a small wound or undergoing PRP treatment, etc., that do not need an overnight stay.
• Vaccinations & Health Check-ups - To get vaccinations and undergo preventive health check-ups.
• Follow-up and Therapies - For physiotherapy and follow-up care that does not require hospitalization.

IPD Treatments:

• Severe Medical Conditions - To avail treatments for severe medical conditions, like dengue fever leading to a low platelet count, which requires prolonged medical observation.
• Major Surgeries - To undergo major surgeries, like an open heart surgery and kidney transplant surgery, that require continuous monitoring, intensive care and hospitalization for a few days.
• Complex Procedures - To undergo complex procedures like childbirth that require specialized care and round-the-clock monitoring to avoid any complications.

Why Buy Health Insurance for OPD and IPD Treatments?

Falling sick is part of life, and so is the occasional trip to the doctor. But with the rise in medical inflation, seeing a doctor on an OPD basis has now become very costly, let alone getting hospitalized.

For instance, women make multiple OPD visits to their gynaecologists in a year, paying a few thousand for each visit. Similarly, parents with small children also have to see a paediatrician on an OPD basis multiple times a year, adding to their medical bills. Besides, a brief in-patient hospitalization for 2-3 days in a private hospital can easily churn out a bill of lakhs of rupees.

Health insurance can help pay for these OPD and IPD costs in exchange for a nominal premium. Most health insurance plans cover in-patient treatment costs, including room rent, ICU charges, OT charges, doctor's fees, non-medical expenses, etc. However, most mediclaim insurance policies offer OPD cover as a rider or an add-on. Moreover, medical insurance allows the insured to avail cashless treatment at any hospital of their choice with the cashless everywhere facility.

How to Buy Health Insurance with OPD and IPD Coverage?

Follow the procedure below to buy health insurance with OPD and IPD cover online:

Step 1: Compare Plans

Compare different health insurance plans online to find policies that cover both OPD and IPD treatments. Some plans may offer in-built coverage for in-patient treatment and OPD cover as an add-on. Compare these plans carefully to find the policy that offers optimal coverage for IPD and OPD treatments.

Step 2: Check Coverage Limits

Before finalizing a plan, check the sum insured and any sub-limits applicable to the policy. Make sure to choose a plan that comes with a decent sum insured of ₹10 lakh or more and offers adequate coverage for OPD expenses without any sub-limits.

Step 3: Go Through Policy Exclusions

Make sure to read the policy terms and conditions carefully to understand what the insurer will not cover. Opt for a plan that has not listed outpatient and in-patient treatment under the list of exclusions.

Step 4: Avoid Co-payments & Deductibles

Avoid opting for plans that come with a mandatory co-payment or deductible. Although co-payments and deductibles may reduce the premium to some extent, they increase the patient's financial liability during claims. Hence, avoiding a health insurance plan for OPD and IPD cover with an in-built co-payment and deductible is better.

Step 5: Check the Premium

Opt for a medical insurance policy with an affordable premium that provides sufficient coverage for OPD and IPD treatment without violating the budget. People can use a health insurance premium calculator online on Policybazaar.com to know the estimated premium for a health policy beforehand.

How Do OPD and IPD Claims Work?

Take a look at how health insurance claims for OPD and IPD expenses work:

1. OPD Claims:

   OPD claims are mostly reimbursement-based. The patient needs to visit the outpatient department of a hospital/clinic and pay for the OPD medical consultation, diagnostic tests, medications and treatments before submitting the medical bills and required documents to the insurer. The insurance company will reimburse the OPD claim amount to the policyholder after verifying the documents.

   However, many health insurance companies offer cashless OPD facilities to policyholders at the healthcare centres under their network.

2. IPD Claims:

   IPD claims are mostly cashless. In the case of cashless claims, the insurer pays for the in-patient hospitalization expenses resulting from major surgeries and complex procedures directly to the hospital. Moreover, the cashless everywhere facility enables patients to avail cashless treatment at any hospital across India as long as they inform the insurer within the stipulated timeframe.

Factors to Consider While Choosing Between OPD and IPD Coverage Under Health Insurance

Here are a few factors to consider while choosing between OPD and IPD coverage under health insurance:

• Medical History – Patients should consider their medical history and the frequency of their visits to the doctor when choosing a plan. People who often go for outpatient doctor consultations should opt for an OPD cover. But those with a history of major illness should opt for health policy with adequate coverage for IPD treatments.
• Premiums – Health plans with OPD cover may be costly. Thus, only patients who frequently visit doctors on an outpatient department basis should opt for OPD coverage while maintaining their budget.
• Age of the Insured – Children and older people should prefer buying policies with both OPD and IPD coverage as they are vulnerable to various health issues and may need to see a doctor or get hospitalized more often.
• Family Size – People who want to buy medical insurance for their whole family should prefer plans with OPD and IPD coverage due to the increased healthcare needs.