Ambulatory care systems and clinical applications

Healthcare - Ambulatory Services

THE ROLE OF AMBULATORY SERVICES

Traditional Ambulatory Medical Services: Until the middle of the 20th century, ambulatory care was the primary method through which physicians furnished medical services. The traditional role of the American physician included home visits to patients in their homes. Generally, patients waited for doctors to treat them at home and the hospital setting was largely reserved for emergency care and surgical procedures (Stanhope & Lancaster, 2004).

As medicine became more industrialized, and medical services evolved to include standard equipment of greater variety and complexity, medical service delivery shifted to the physician's office, often in close proximity to hospital facilities. Likewise, physicians cared for more and more patients and the traditional house call became a rarity reserved for patients willing to pay a high premium for that convenience.

Modern Ambulatory Services:

Today, most routine medical services are still delivered through ambulatory services, but almost always at the physician's office. However, in many cases, patients seek primary treatment from hospital emergency departments, frequently because they do not maintain health insurance. Since emergency departments are obligated by law to treat all patients, the increase of uninsured patients seeking primary (i.e. non-emergency) medical care from hospital emergency rooms has generated a significant financial crisis because public funds are not always sufficient to enable the facilities to maintain operations. Consequently, many American hospitals have had no choice but to eliminate their emergency rooms altogether (Stanhope & Lancaster, 2004). One solution to this problem of providing adequate ambulatory services was the establishment of urgent care centers designed to provide medical services to treat patients who would otherwise overwhelm hospital emergency departments.

In the current era of managed care in medicine, physicians and other healthcare providers and institutions have been under tremendous pressure to reduce costs. In that regard, avoiding unnecessary hospitalization is one of the most important goals of lowering the costs of healthcare delivery (Stanhope & Lancaster, 2004). Toward that end, diverse strategies have evolved to provide as many healthcare services as possible on an ambulatory basis.

Hospitals and insurance companies now encourage patients to participate in preventative medicine and routine testing intended to lower the costs associated with hospitalization over the long-term. The strategy is simply to reduce the incidence of serious illnesses, particularly those that typically develop over many years and which are capable of prevention through behavior modification and early detection through diagnostic testing (Stanhope & Lancaster, 2004).

Because state and federal governments must absorb much of the costs of uncompensated medical services, the many administrative agencies within the U.S.