History/Overview

An important system of health care in the United States that is becoming increasingly more popular is outpatient and primary care. A general definition of outpatient care is any health care service where room and board costs would be applied. Another widely accepted name for outpatient care is ambulatory care, which can be described as any health service or treatment provided to the “walking” patient.
Historically speaking, physicians typically provided all of the health services including diagnosis, treatment, and surgery, because less was known about medical science. At this time in history inpatient care such as nursing homes and hospitals were unheard of. Eventually hospitals became the center of health care delivery when services began to expand. Hospitals were well equipped with technology and supplies which made it difficult for independent providers because of the competition in the health care marketplace. Recently, outpatient care has moved away from hospitals being the main providers for services. New settings have emerged which contribute to the growth of outpatient services in the United States.
Primary care is the base for outpatient health services but not all outpatient care is primary care. Primary care includes prevention, diagnostic and therapeutic services, health education and counseling, and minor surgery (SS 247). Many secondary and tertiary treatments are being provided in outpatient care services because of the advances in medical technology. Some examples of outpatient care are home health care, ambulatory clinics for routine and urgent care, and outpatient surgery.
The cost of ambulatory care is good for the patient in comparison to inpatient care. Patients are able to go home after certain procedures instead of staying overnight and racking up extra hospital bills. Public and private payers prefer outpatient treatment which is a financial incentive for hospitals to continue to develop outpatient services (SS 256). MCOs are putting an emphasis on preventive and outpatient care and are making huge efforts to cut costs. A downside to the fragmented system in the United States is the lack of access to primary care which has become a huge problem. Many uninsured citizens are unable receive primary care and without checkups, serious health conditions go on untreated until secondary or tertiary stages. An excessive amount of money is being spent on treating health conditions that could have been prevented or would have been less expensive if they were treated earlier.
According to The International Journal for Quality in Health Care, “Concerns about access, particularly with respect to primary care, are compounded by an aging health care workforce, the increased prevalence of chronic disease and the complexities of team-based contemporary practice”(Geneau et al.). Ambulatory services such as public health services and free clinics are available to inner city, poor, and uninsured populations. Throughout the past 20 years, many freestanding outpatient centers and satellites operated by inner city hospitals have emerged in the suburbs (SS 257). Community members are more likely to utilize services when they are closer and easier to access. Prior to the 1980s, health insurance coverage was more generous for inpatient services than for outpatient services, however times have changed and today private and public payers clearly prefer outpatient treatments (SS 256). Today, individuals are able to receive procedures in ambulatory settings, which once could not have been possible, thanks to shorter-acting anesthetics and the growth medical technology.
Outpatient care provides increased quality because of the growth of technology and equipment and the money being spent on services. Hospitals have been seeing inpatient revenues steadily eroding, and they have started to spruce up and expand outpatient services (SS 250). Many patients prefer home health care or community based settings instead of being institutionalized which is exactly what ambulatory services give them.
Outpatient and primary care is more important than the other systems because it incorporates a focus on prevention. If universal access was achieved in the United States, everyone could have primary care visits which would increase earlier interception of diseases and conditions. Outpatient care is extremely important for individuals who do not wish to be institutionalized because it gives the patient the option to either go home after a visit or receive care from their own home. Some people believe outpatient care is less important because they think patients should be able to go straight to a specialist instead of seeing their primary care physician first. Shi and Singh state, “when a person’s comprehensive health care needs are coordinated by a trained primary care professional, it leads to better health outcomes and cost efficiency” (SS 282).

Shi, L., & Singh, D. A. (2008). Outpatient and primary care services. In Delivering health care in america: A systems approach (4th ed., pp. 244-282). Boston: Jones and Bartlett.



Geneau, Robert, et al. “Framework for primary care organizations: the importance of a structural domain”. International Journal for Quality in Health Care 20.5 (30 Nov. 2007): 18 Feb. 2009 <>