Understanding the difference between inpatient and outpatient care
When looking for the right health insurance in China, it is essential to understand what level of protection you need. Should your policy include outpatient care, or inpatient only is enough? What is the difference between those two? How much price difference are we talking about if include one but exclude the other? In this article we will cover all of the above plus review some of the essentials in terms of policies available on the market.
Key takeaways
Up until 2024, there was no way you could purchase outpatient only insurance in China. It was always required to have core benefits (inpatient) included into the policy before you could opt for outpatient. As the time goes on, more and more options are available for expats in terms of health insurance. Let’s dive in.
What is inpatient care?
Most insurance companies define inpatient care as a treatment where overnight stay in a hospital is medically necessary. In simple words, you are admitted in the ward and get a wrist band. Such type of treatment always needs to be pre-authorized with your insurance provider. If you are in direct billing facility they can arrange this for you. Otherwise seek help from your agent or a broker.
Inpatient medical care typically includes very severe cases where doctors need to monitor your health over certain period of time. Some companies have a very specific definition where you need to “occupy a bed” in the hospital in order for treatment to be inpatient. Examples of such include:
- major surgeries
- child birth
- ICU treatments as well as life threatening conditions such as stroke or a heart attack
What is outpatient care?
” Treatment provided in the practice of a medical practitioner, therapist or specialist that does not require you to be admitted to hospital. ” Such detailed explanation is part of Allianz literature. You can typically be on your way out of hospital or clinic once outpatient visit is over. To keep it simple, that includes any treatment where you don’t need to stay overnight in the hospital. Examples of such include:
- family doctor visits or consultations with specialists
- diagnostic procedures such as blood tests, X-Rays, and other scans
- getting prescriptions
- therapies such as physiotherapies, TCM or acupuncture
Big confusion some expats in China have – emergency don’t necessarily mean inpatient. For example if you break a leg during holidays in Thailand, that is definitely an emergency. But it almost certainly will not require you to stay in the hospital. You are most likely consult orthopedician, get an X-Ray done, get a cast, and you will be sent home. This is a perfect example of an outpatient care visit.
Do all health insurance plans in China provide inpatient and outpatient care?
Up until very recently, if you wanted to include outpatient care in your policy – you would need first purchase inpatient raider. Right now there are options that allow you purchase outpatient only insurance. This becomes very popular among expats not planning to stay in China for long. Additionally, among locals who will use social insurance for any inpatient treatment they may need.
You should always purchase health insurance for the peace of mind as well as protection against high medical bills. How much level of cover you need is entirely up to you. If you are a person that didn’t go to see a doctor even once in the past 5 years, then inpatient only plan might be a good fit. On the contrary, expats with kids tend to get plans with outpatient since visiting pediatrician becomes more and more common with children. To further elaborate, sometimes family members can split policy as well in terms of cover. Meaning, parents can end up purchasing inpatient only insurance while kids can be on both in&outpatient plan.
Always keep in mind that level of cover in your insurance plan in China should be determined by your health needs. A person can have an inpatient only plan and not use it for 5 years straight. On the other hand, outpatient care raider gives you more flexibility to visit family doctors and specialists for minor things once every other month.
What is the price difference between inpatient and in&outpatient health insurance?
Adding outpatient benefits into your health insurance in most cases will double the yearly premium. That is of course also depends if you have full cover on the plan or with deductibles/copayments. Outpatient care is where insurance companies reimburse the most which is why it is always the most costly part. An average inpatient only plan for a 35 year old expat will run you between RMB 6000-10000 per year. This also will depend if you get a local plan for cover in China only or globally, as well as if you have any deductibles as part of the cover.
Adding outpatient raider on this will get the price up to RMB 18000+. Sky is the limit here as there are insurance companies with comprehensive plans that will be happy to give you price tag of over RMB 50000. The more premium you are ready to pay for your insurance, the higher level of protection you can expect in your policy.