Outpatient care refers to any visit that is less than 24 hours. Outpatients are not required to spend the night in the hospital and are able to come and go on the same day.1 Today outpatient care is referred to as ambulatory care. But unlike the term ambulatory care, outpatient care is more comprehensive because not all patients “walk” (ambulatory) to a care facility, but instead can arrive by air or land ambulance to a hospital ED that provides secondary and tertiary care. An essential part of outpatient care is primary care. The main services that primary care provides is, prevention, diagnostic and therapeutic services, health education, counseling, and minor surgery.
Outpatient care has been around for a long time and due to innovation in technology and medical services, many patients are now receiving their care same day without lengthy visits and overnight stays. Decades ago, many physicians would have patients visit their clinics, which were independent of hospital facilities, or they would visit their patients personally in the comfort of their own home. The patient-physician relationship in those days was very strong because in general the physician would take on many medical services. As medical technology advanced and services expanded, outpatient care began to shift to hospitals settings. With the increasing costs of inpatient care and the increasing innovation in medical technology, outpatient care became the dominant approach. Just a couple decades ago, chemotherapy and mastectomy patients were in the hospital for at least a week. Nowadays patients are receiving these type of treatments in outpatient care facilities.
An example of the shift from inpatient to outpatient care happened in the 1990's at the Nation Jewish Hospital. In 1995, the Nation Jewish hospital set up a day-treatment program in pediatrics that provided day treatment for children.2 The reason for this shift was increasing technology and better services, as well as to control costs. According to Michael S. Ewer, M.D., special assistant to the vice president and chief medical officer at M.D. Anderson, “Much of the move toward outpatient care in this country has been driven by third-party payers in an effort to control expenses.”3 Michael S. Ewer also mentioned that it benefited patients by challenging health care providers to provide an effective and safe way to provide outpatient care. As well as driving down health care costs, 90 percent of patients according to Carmen P. Escalate, M.D., an associate professor in the Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care, would rather come in daily then be admitted for the whole five days.
Outpatient care is most likely to endure as long as costs are kept down. It is also to the advantage of hospitals and other care facilities to treat patients quickly and send them on their way. Today there is a shortage of inpatient hospital beds throughout the country, which could lead to overcrowding. The best option would be to provide inpatient beds for the very sick. Unfortunately, the aging population is stuck with a higher co-payment through Medicare which is leading to less routine primary care doctor visits, resulting in more expensive care and worsening health down the road; according to a New York Times article.4 Hospital administrators are realizing that they need to keep a strong preference for outpatient care if they plan to keep their organization from crumbling. We as a group believe costs are crucial when it comes to outpatient/primary care. If Medicare co-payments increase then we agree that individuals will not seek the care they need until its to late and inpatient care will result, which in-turn will become more costly.
Shi, Leiyu and Douglas A. Singh. “Delivering Health Care inAmerica: A Systems
Approach.” 4th Ed. Sudbury, MA: Joans and Barlett Publishers, 2008. (247,250-251)
1 Jeffries, Melissa. "How Inpatient and Outpatient Benefits Work".
2 "Clinical History (3 of 3)". National Jewish Health.
3 Meeting the Rising Demand for Outpatient Care 49.11 (2004). Outpatient Care. OncoLog. Web. 21 Feb. 2010.
4 Rabin, Roni C. "Aging: Higher Co-Payments Tied to Costlier Care." New York Times - Health. New York Times, 1 Feb. 2010. Web. 21 Feb. 2010.
I agree that costs are crucial to outpatient/primary care. If older individuals are waiting to see a physician because of the burden of cost, then the system needs to be revamped because if they are waiting then they are more likely to need more expensive care later which will add to the costs even more. I also agree that most people would rather see the doctor daily than stay overnight which also reduces costs.
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