Inverting the healthcare pyramid: building synergies between outpatient care and inpatient hospitalisation

Abstract The efficient integration of outpatient (OPD) and inpatient (IPD) care is a critical challenge in modern healthcare, essential for maximising patient-centred care and resource utilisation. OPD, encompassing preventive services, routine check-ups, and chronic disease management, aims to minimise the need for hospitalisations. Conversely, IPD remains crucial for acute interventions and complex medical needs. This paper investigates the nuanced relationship between OPD and IPD: specifically, we seek to determine if increased OPD utilisation while improving overall health, leads to a reduction or increase in subsequent IPD utilisation, duration, and associated costs. We analyse anonymised data from Indian organisations providing company-sponsored OPD and IPD insurance to their employees between 2021 and 2024. By examining the correlation between OPD utilisation patterns and IPD outcomes, we aim to provide data-driven insights for effective healthcare integration strategies. Furthermore, we explore the feasibility of developing a personalised “Wellbeing Rating” derived from longitudinal OPD insurance utilisation data. This automated methodology aims to provide a continuous, dynamic health assessment, moving beyond the limitations of traditional, sporadic medical examinations by leveraging the comprehensive data inherent within insured OPD coverage.