A Changing Service - Three alternative systems

Obviously, office and clinic care takes many forms. Three alternatives that provide relatively minor, low-level services are the hospital outpatient department, the ambulatory surgical center, and the freestanding emergency center. Each plays a particular role in the health care delivery network.

Hospital Outpatient Departments

Outpatient departments once offered free services as a means of training medical students and residents or because physicians volunteered their services for such departments. Today, outpatient departments charge for their services while delivering health care that varies broadly as regards quality. One hospital in three has an outpatient department or a clinic for ambulatory care while nine of ten community hospitals offer outpatient care in their emergency departments.

Ambulatory Surgical Centers

Sometimes called surgicenters, the ambulatory surgical center may be attached to a hospital or be completely independent. In either case, the surgicenter may be an effective alternative in the traditional situation where a patient needs a dilatation and curettage (D & C), hernia repair, or tissue biopsy. Because they perform lower-risk procedures, ambulatory surgical centers can keep costs down. Local anesthesia is the norm, and usually the patient goes home on the day of the operation.

Freestanding Emergency Centers

Sometimes called urgicenters , freestanding emergency centers resemble hospital emergency departments. But private, for-profit groups usually run them. Open from 12 to 24 hours daily, they operate on a drop-in basis, meeting a definite need where a hospital emergency room is far away or when all physicians’ offices have shut down for the day. Typically, emergency centers treat sprains and bruises, cuts that require stiches, and upper respiratory infections. Charges for such services usually range from visits to physicians’ offices on the low side to hospital emergency rooms on the high side.