Ambulatory care services and clinical applications

Ambulatory Care

There are both advantages and disadvantages to increasing the number of physicians who limit their activities to narrower fields of practice. The advantages include the fact that because there are more specialists and there are more options for patients who actually need truly specialized care. As such, scheduling appointments and even time spent traveling to appointments is more manageable as specialists are considerably more accessible in the modern era, which was one of the goals of the Affordable Care Act (Hawkins and Grove, 2014, p. 90). The disadvantage, of course, is that there is now a specialist culture within health care. As such, patients have to pay to see a doctor twice before they can get what they need done. Most health insurance companies do not allow patients to simply go to a specialist without a referral from their primary care physician first. As such, the patient ends up shouldering more of the cost to see a specialist.

The shifting of care settings from acute hospital to ambulatory care centers also reflects the specialist culture existent in health care within the U.S. Ambulatory care centers now are typically used for the purposes of specialized health care treatment. In some instances, such as oncology, specialization is virtually required (Lee and Fitzgerald, 2012, p. 19). There are many services which hospitals once provided that patients can now receive in ambulatory care centers. There are some advantages to this fact. Oftentimes, an ambulatory care center -- especially one that is focused on a particular area of specialization -- has less of a stigma attached to it than acute care hospitals. There are certain people who believe that hospitals are disadvantageous to people and that they can actually be detrimental to the health and well-being of a patient. In this respect, then, the shifting of services from acute hospitals to ambulatory care centers is beneficial.

As a patient, I can easily say that the focus on specialization within the health care field in this country is certainly not a good thing. Essentially, the fact that patients oftentimes need to go to two providers in order to get what they need -- which requires two co-payments -- creates much more bureaucracy than there needs be. Additionally, it is worth noting that several insurance companies offer plans in which customers have to pay a significantly larger co-payment to see a specialist. There are also plans in which specialists are simply not included in the provider network, and patients are left having to pay for the entire cost of the visit to a specialist -- when these patients have already gone through the arduous process of establishing health insurance. Essentially, having to go to specialists merely exacerbates the bureaucracy that typifies the health care system in the U.S. I have a nephew who simply needs prescription hydrocortisone to reduce razor bumps when he shaves. In order to do so, he has to first go to his primary care physicians and pay an additional co-pay along with the fee for the medicine -- when all he needs is the medicine. These practices are too common and not fair.