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ambulatory care
care for an individual presenting for personal health services, who is neither bedridden, nor currently, admitted to any health care institution
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private practice
- solo: fee for service, self-employed, on decline
- partnership or group: joint ownership, less individual fee
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managed care organization
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HMO
- prepayment for service on a per member per month basis
- enrollees pay a fixed fee for services
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PPO
contracts with health providers under a discounted fee-schedule
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Health Department services
- 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
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Neighborhood and Community Health Centers (CHC)
- 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
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Indian Health 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
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school health clinics
- provide health education for students
- maintain safe and healthy school environment
- personal health services
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Voluntary agencies
- American Red Cross
- Salvation Army
- Church missions
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Free Clinics
- 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
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hospital-based ambulatory care
- emergency room
- outpt clinic
- outpt diagnostic / therapeutic services
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emergency 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
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out pt clinic
- 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
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ambulatory surgery centers
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
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