Common Outpatient Illnesses: Treatment Options and Medical Insurance Benefits in Malaysia

Outpatient illnesses can disrupt our daily lives considerably. They often lead to unexpected medical expenses that strain our finances. Without proper management, these illnesses not only affect physical health but can also lead to lost productivity and increased healthcare utilisation.

Unanticipated medical bills can accumulate quickly, especially when multiple visits to healthcare providers are required. Even with insurance, patients may still face high out-of-pocket expenses, especially if their plans have limited coverage for specific medications.

What is outpatient?

Outpatient care is the term for medical services that don't require a patient to spend the night in a healthcare institution. This type of care entails a variety of medical consultations, operations, and therapies that enable patients to receive care and go home the same day.

Typical outpatient services include:

• Physical therapy.

• Minor surgery.

• Blood testing.

• Diagnostic imaging (such as MRIs and X-rays).

• Routine preventative annual checkups.
  
  

Outpatient treatment can be given in various locations, including urgent care centres, primary care clinics, and outpatient surgical centres, making it a practical and affordable choice for many individuals.

Outpatient care's main differentiators are its affordability and accessibility. Because it avoids the expenditures of overnight stays, like prolonged medical supervision, it typically has cheaper prices than inpatient services. Outpatient care also enhances health outcomes while lessening the strain on hospital resources.

What is inpatient?

The term "inpatient care" describes the medical attention given to patients who need to stay overnight at a health facility. Inpatient care is usually given to people with serious medical disorders that require close observation and specialist treatment.

Traumatic injuries, major surgeries, childbirth, severe illnesses, and chronic ailments are among the common causes of inpatient admission. With all-encompassing medical measures, the fundamental premise of inpatient care is stabilising the patient's state and promoting recovery.

The value of inpatient care resides in its capacity to deliver a higher calibre of medical treatment that’s not possible with outpatient services. Patients are monitored and treated round-the-clock, which is essential for people with complex medical conditions that require more intrusive treatments and therapies. Following stabilisation, patients may be sent home with directions for continued recuperation and condition control.

Inpatient vs outpatient cost

Major disparities exist between inpatient and outpatient expenses. These are mostly due to the type of care provided and related services.

Inpatient treatment involves a patient's admission to a hospital, where they remain overnight or longer and require ongoing medical supervision. This type of care is generally more expensive due to the 24-hour monitoring, room and board, specialised medical staff, and various treatments. Some inpatient expenses may even include facility fees for prescription drugs, lab work, and speciality equipment used in treatment.

On the other hand, outpatient care doesn't necessitate an overnight stay. As such, it is typically less expensive. Costs mainly consist of physician fees and any necessary tests or procedures performed during the visit. Some minor surgeries can even be outpatient procedures, allowing the patient to return home.

Common outpatient illnesses

Outpatient ailments vary in severity, impacting not only physical health but also one’s finances and emotional well-being. In fact, many of these illnesses can escalate if left untreated. Here is a list of some of the most prevalent outpatient diseases, their causes and treatment procedures.

Asthma

Asthma is a chronic respiratory condition characterised by inflammation and narrowing of the airways. It often leads to symptoms such as wheezing, shortness of breath, chest tightness, and coughing. 

Various factors can trigger this outpatient illness. For example, allergens (like pollen and dust mites), respiratory infections, cold air, and tobacco smoke.

Bronchodilators are usually used to alleviate symptoms. Inhaled corticosteroids can also be used to lessen inflammation in the airways. To properly manage the illness, patients may need frequent lung function monitoring and are frequently advised to stay away from recognised triggers.

Chronic sinusitis

Chronic sinusitis is a prolonged infection of the sinuses. It causes symptoms like thick nasal discharge, facial pain or pressure, nasal congestion, and diminished smell.

Persistent infections, allergies, or anatomical issues such as nasal polyps may cause it. Its treatment frequently consists of antibiotics, saline nasal irrigation to remove mucus, and nasal corticosteroids to reduce inflammation. Minor surgery may be required in certain situations to improve sinus drainage.

Hypertension

Hypertension (high blood pressure) occurs when the force of blood on the walls of arteries is constantly too high. It often develops due to factors such as obesity, physical inactivity, excessive alcohol consumption, high salt intake, and genetic predisposition.

Hypertension is often asymptomatic but may escalate to health issues like heart disease and stroke if left untreated. Effective management typically entails lifestyle changes (diet and exercise) as well as medications like ACE inhibitors, diuretics, or beta-blockers to help control blood pressure levels.

Diabetes

Diabetes is a chronic illness that occurs due to the body's inability to use insulin to control blood sugar levels. There are two main types of diabetes. Type 1 diabetes, which is usually autoimmune, requires insulin therapy from diagnosis. Type 2 diabetes is typically related to lifestyle factors like obesity and physical inactivity.

Increased thirst, frequent urination, exhaustion, and blurred vision are possible symptoms of diabetes. Overall, the goal of diabetes treatment is to control blood sugar levels through diet and activity changes, frequent blood glucose checks, and drugs like insulin or oral hypoglycemics.

Pneumonia

Pneumonia is an outpatient illness that causes inflammation of the air sacs in one or both lungs, where they may fill with pus or fluid. Typical symptoms include fever, chills, coughing (which may cause mucus), and trouble breathing.

Viruses (like influenza), fungi, or bacteria (most frequently Streptococcus pneumoniae) may all cause pneumonia.

In practice, the cause of the pneumonia determines the course of treatment. Bacterial pneumonia typically requires antibiotics, but viral pneumonia may require supportive measures like rest and fluids. Hospitalisation may be necessary for more intense therapy in severe situations.

For more on pneumonia, read ‘Pneumonia: Causes, Treatment Options, and How Insurance Can Support Your Recovery’. 

Osteoporosis

Osteoporosis is a condition that weakens and brittles bones, considerably increasing the risk of fractures. It often develops silently over many years without symptoms until a fracture occurs.

Risk factors include ageing, hormonal changes (especially in women post-menopause), low calcium intake, a sedentary lifestyle, and certain medications.

Its treatment regimens focus on strengthening bones through medications like bisphosphonates, calcium and vitamin D supplementation. Lifestyle changes such as weight-bearing exercises may also improve bone density.

Hypo/hyperthyroidism

Hypothyroidism is caused by low thyroid hormone production by the thyroid gland.

This typically manifests as depression, weight gain, lethargy, and cold sensitivity.

On the other hand, hyperthyroidism is characterised by an overabundance of hormones. Consequently, it manifests symptoms of anxiety, heat sensitivity, weight loss, and a fast heartbeat.

Both conditions may be caused by autoimmune diseases (such as Hashimoto's for hypothyroidism or Graves' disease for hyperthyroidism) or iodine deficiency.

Hypothyroidism is usually treated with levothyroxine hormone replacement treatment. On the other hand, hyperthyroidism typically dictates radioactive iodine therapy or antithyroid drugs.

Anaemia

Anaemia is a disorder in which the body's tissues don’t receive enough oxygen from the red blood cells. Shortness of breath, weakness, exhaustion, and pale complexion are some of its most common symptoms.

Anaemia may be caused by iron deficiency (because of poor dieting or blood loss), vitamin B12 deficiency (due to dietary insufficiency or absorption issues), chronic diseases (like kidney disease), or bone marrow disorders.

Anaemia treatment focuses on addressing the underlying cause. For example, vitamin B12 injections can be used for deficiency anaemia, and iron supplements can be used for iron deficiency anaemia.

Gastroesophageal reflux disease (GERD)

GERD is a digestive disorder. With GERD, stomach acid frequently flows back into one’s oesophagus—causing irritation, heartburn and regurgitation.

Factors that contribute to the emergence of GERD include obesity, pregnancy, smoking, certain foods (such as caffeine and spicy foods), and anatomical issues like hiatal hernias.

GERD treatment typically involves dietary changes, over-the-counter antacids for symptom relief, and proton pump inhibitors to reduce stomach acid production.

Urinary tract infection (UTI)

A urinary tract infection (UTI) is an infection of the urinary system—the kidneys, ureters, bladder, or urethra—that causes painful urination and frequent urges to urinate.

UTIs are most often caused by bacteria entering the urinary tract. Due to anatomical differences, women are at higher risk. Treatment generally involves antibiotics to eliminate the infection. Increased fluid intake can also help flush out bacteria from the urinary system.

Dermatitis

Dermatitis is a skin inflammation that causes rashes or red, itchy areas. Common forms include contact dermatitis, which is caused by skin exposure to chemicals like soaps or plants (such as poison ivy), and atopic dermatitis (eczema), which is caused by allergens or irritants.

Topical corticosteroids are frequently used to counter inflammation, while antihistamines relieve itching. Avoiding known irritants is also crucial for managing dermatitis.

Rheumatoid arthritis (RA)

RA is an autoimmune disorder that predominantly affects joints. It causes inflammation that leads to pain, stiffness (mainly in the morning), swelling, and potential joint damage.

Its exact cause remains unclear but may involve genetic predisposition combined with environmental triggers that provoke an immune response against joint tissues. Effective management typically entails anti-inflammatory medications (NSAIDs) for pain relief and disease-modifying antirheumatic drugs (DMARDs) to slow disease progression.

Minor surgeries

The following minor surgeries do not require hospitalisation:

Hernia repair

This surgical technique corrects a hernia in which an organ pulls through a hole in muscular tissue. It can be performed openly or laparoscopically, depending on the hernia’s size and location.

Tonsillectomy

A tonsillectomy removes the tonsils of patients with recurrent infections or obstructive sleep apnea. It is typically performed under general anaesthesia, and patients usually recover at home afterwards.

Gallbladder removal

Cholecystectomy entails removing a gallbladder that has been affected by gallstones. This surgery can be done laparoscopically with minimal recovery time required.

Cataract surgery

Cataract surgery removes cloudy lenses from the eyes, utilising advanced techniques to restore vision clarity. It is usually performed under local anaesthesia.

Minor orthopaedic procedures

Minor orthopaedic surgeries include arthroscopy for joint issues like torn cartilage or ligament repairs. These surgeries are often performed under local anaesthesia and have quick recovery times, allowing patients to resume normal activities soon after. 

Other outpatient procedures

The following outpatient procedures also do not require patients to stay in the hospital:

Imaging services

Imaging services are indispensable for diagnosing various medical conditions via non-invasive techniques. Common imaging procedures include:

• MRI (Magnetic Resonance Imaging):This technique exploits strong magnets and radio waves to produce comprehensive images of organs and tissues. It is especially helpful when examining the brain, spinal cord, joints, and soft tissues to diagnose conditions such as tumours, brain disorders, and musculoskeletal injuries.

• CT scan (Computed Tomography):A CT scan combines X-ray images with computer processing to create cross-sectional images of blood vessels, soft tissues and bones. It is commonly employed to detect cancers, internal injuries, and bleeding.

• X-ray:Leveraging electromagnetic radiation to penetrate the body, x-rays are widely used for diagnosing fractures and other conditions affecting the skeletal system.

Cancer treatments

Outpatient cancer treatments are mission-critical in the management of various types of cancer while allowing patients to maintain their daily routines. For example:

• Chemotherapy:This therapy involves employing powerful drugs (orally or intravenously) to eradicate cancer cells or stop their growth.

• Radiation therapy: This unique treatment exploits high doses of radiation delivered via a specialised machine to target and kill cancer cells.

Health screenings

Health screenings are preventive measures designed to detect potential health issues early. For instance:

• Colonoscopy:This procedure examines the inner lining of the colon, utilising a flexible tube with a camera to detect colorectal cancer and polyps.

• Endoscopy:This procedure exploits a flexible tube with a camera down the throat to examine one’s stomach, oesophagus, and upper part of the small intestine to diagnose ulcers or gastroesophageal reflux disease (GERD).

• Mammograms: These are specialised X-rays of the breast exploited to detect breast cancer early.

Minor emergency care

Minor emergency care encompasses interventions for less severe injuries or illnesses that don't require hospitalisation. For instance:

• Wound stitching:This procedure entails methodically closing cuts or lacerations with stitches (sutures) to promote healing and prevent infection.

• Simple fractures:Minor fractures are treated using splints or casts without the need for surgical intervention.
  
  

Outpatient insurance Malaysia

In Malaysia, outpatient insurance is intended to cover medical costs that are incurred outside of a hospital stay. It is ideal for people seeking to manage their healthcare expenses efficiently, particularly for regular checkups, minor procedures, and treatments for common ailments. Usually given out during enrollment, a medical card enables policyholders to access a network of healthcare providers without having to pay in advance.

PRUMillion Med Active

PRUMillion Med Active is a comprehensive active pricing medical insurance plan that allows members to pay less when they claim less without compromising coverage.

This plan rewards a healthy lifestyle with an upfront 15% discount on premiums whilst catering to different outpatient treatments, including consultations, diagnostic tests, and medications.

Policyholders benefit from a medical card that facilitates cashless transactions at dedicated providers, ensuring hassle-free medical access.

PRUMillion Med 2.0

PRUMillion Med 2.0 is another insurance product that provides extensive outpatient coverage alongside inpatient benefits. This plan emphasises flexibility and comprehensive protection against unexpected outpatient medical expenses.

It has no lifetime limit and with an annual limit of up to RM8 million. One can further enhance their coverage with the booster, which provides an instant additional annual limit of RM10 million. You are also rewarded if no claims were made in the preceding year.

PRUValue Med

PRUValue Med focuses on delivering essential outpatient coverage while allowing policyholders to customise their plans according to their healthcare needs.

This plan includes benefits for consultations, diagnostic tests, and preventive care services. Thus, making it an attractive choice for individuals seeking comprehensive yet cost-effective outpatient coverage.

Conclusion

Outpatient illnesses can significantly disrupt daily life, often catching individuals off guard and leading to unexpected medical visits. Fortunately, medical insurance can alleviate the burden of these illnesses.

It makes it easier for people to obtain the healthcare services they require, guaranteeing prompt treatment and preventative care. This results in better health outcomes and lower healthcare expenditures.

Furthermore, insurance lessens the financial burden of medical bills to allow patients to concentrate on getting better rather than worrying about money.