ambulatory care

care for an individual presenting for personal health services, who is neither bedridden, nor currently, admitted to any health care institution

• solo: fee for service, self-employed, on decline
• partnership or group: joint ownership, less individual fee

• HMO
• PPO

• prepayment for service on a per member per month basis
• enrollees pay a fixed fee for services

contracts with health providers under a discounted fee-schedule

• communicable disease control: contagious diseases, STDs
• maternal and child health: low-income families, prenatal care, well-baby care
• chronic diseases: preventative care, and screening
• general ambulatory care: low-income pts, underserved areas

• federal grants from Community Health Centers acts of 1974
• 650 CHC organizations operate 2500 clinics serving over 11 million pts
• Criteria: high poverty level, excessive infant mortality, shortage of pcp
• mandated services: diagnosis, treatment consultation, laboratory and imaging services, dental services, social services, and pharmaceutical services

• IHS
• mission: to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level
• originated based on relationship btwn the federal govnt and indian tribes in 1787
• 49 hospitals and 545 ambulatory health centers
• serves 1.9 million Native Americans and Alaska Native on or near reservations in 35 states

• provide health education for students
• maintain safe and healthy school environment
• personal health services

• American Red Cross
• Salvation Army
• Church missions

• 1. physical facility
• 2. trained health personnel (usually volunteers)
• 3. other health staff and volunteers
• 4. direct provision of medical, dental, and psychological  services, including treatment of drug abuse
• 5. available to all 
• 6. specified hours of operation
• 7. no set payment required, small fees or donations may be required
• major obstacles: financing and staff

• emergency room
• outpt clinic 
• outpt diagnostic / therapeutic services

• hospital emergency service: 93% of community hospitals have emergency departments
• 3 types of cases:
• 1. emergent (5%): needs immediate medical care
• 2. urgent (45%): needs medical care within hours
• 3. nonurgent (50%): minor or non-acute in severity
• -high resource for low acuity
• -could be managed at more cost-effective venue
• -frequently used by pts with not regular physician or less ability to pay at time of service

• teaching hospital clinics
• functions as group practices
• 3 types:
• 1. medical 
• 2. surgical
• 3. specialty
• -supervised teaching opportunity for interns/residents 
• -lower cost to pts is a trade-off for teaching
• -usually for: low income pts, follow-up visits
• -consultations

diagnostic and therapeutic services

• hospital-based or free-standing
• surgeries and procedures not requiring admission
• pt goes home the same day as procedure
• less time/ lower cost
• preffered by 3rd party payers
• high level of pt satisfaction