ambulatory care

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  1. ambulatory care
    care for an individual presenting for personal health services, who is neither bedridden, nor currently, admitted to any health care institution
  2. private practice
    • solo: fee for service, self-employed, on decline
    • partnership or group: joint ownership, less individual fee
  3. managed care organization
    • HMO
    • PPO
  4. HMO
    • prepayment for service on a per member per month basis
    • enrollees pay a fixed fee for services
  5. PPO
    contracts with health providers under a discounted fee-schedule
  6. 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
  7. 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
  8. 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
  9. school health clinics
    • provide health education for students
    • maintain safe and healthy school environment
    • personal health services
  10. Voluntary agencies
    • American Red Cross
    • Salvation Army
    • Church missions
  11. 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
  12. hospital-based ambulatory care
    • emergency room
    • outpt clinic 
    • outpt diagnostic / therapeutic services
  13. 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
  14. 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
  15. 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
Card Set
ambulatory care
health care
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