Article by Darlene Oakley
In our grandparents’ day, health care began with a family physician, with most every surgery and other more invasive or involved treatments being referred to a hospital. It used to be that a mother who had just given birth would have stayed up to two weeks before being sent home. A similar time was assumed for post-surgical recovery. Many patients are now discharged within a day or two of surgery, and surgeries are performed on an outpatient basis where possible, reducing the need for hospital personnel and spaces.
As primary care medical practitioners and facilities have evolved over the past few decades, there has been a decided shift to non-hospital-centered care. Improved anesthetics and medications and other community-oriented health care centers have meant that patients are discharged from hospital sooner. Some patients obviously require home care provided by a registered nurse or psychiatric services to continue their recovery. Other patients, however, may not even be aware that home health care support services are available.
Obviously, this particular issue cannot be completely covered in a single article, at least not one that many people would read to the end of. So, we will examine this emerging health care trend over a series of articles. This article will look at how this trend came about. How did we go from hospital-centric care to community-health-centric care. This may get a little technical as we look at some of the statistics, but it’s important to know how we got here and where the trend appears to be going.
A Shift in Health Care
Peoples’ specific needs for health care are always changing. Just like every other industry, the health care sector has had to respond to patients’ needs. Not every surgery requires a hospital stay. Not every medical treatment requires a hospital stay. Shifting to outpatient services frees up hospital spaces for those who truly need hospital-based care, and helps to more successfully transition people from hospital to home and back to a semi-normal, pre-treatment or post-treatment life.
A 2004 series of studies conducted by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, and National Center for Health Statistics found that overall visits to hospital outpatient departments increased by 29 percent between 1992 and 2000 – a time when hospitals started placing greater emphasis on providing and expanding their outpatient services. In 2006, outpatient care accounted for $850 billion or 41 percent of health care spending in the United States (TheIncidentalEconomist). Another study found that nearly 88 million people seek medical care or treatment from an outpatient facility per year in the United States (WebMD).
These outpatient services include (from WebMD):
• Pain clinics
• Rehabilitation centers
• Medical group practices
• Outpatient clinics at hospitals or other medical facilities
• Surgery centers
• Imaging centers
• Cardiac catheterization centers
• Mental or behavioral health centers, substance abuse treatment services and mental health services for adults or adolescents
• Laboratory centers
• Gastrointestinal centers (colonscopy and endoscopy)
• Durable medical equipment rental facilities
• Physical therapy centers
• Chemotherapy and radiation therapy centers
As is kind of clear from the above list, outpatient health care facilities tend to specialize in a particular area of medicine such physiotherapy or medical imaging.
The Business of Health Care Costs
Patient care needs aren’t the only driving force behind this trend. Money is also a driving force. As much as health care is necessary, employers who are trying to manage care enrollment, as well as major Medicare and Medicaid cost containment efforts such as the Prospective Payment System for hospitals, are always looking for ways to cut their costs. These incentives as well as incentives for physicians (Resource Based Relative Value Scale) continue to dictate where and what services are provided (CDC). These initiatives are meant to financially reward physicians and employers faster – the physicians get paid faster and the employers manage shorter sick-leave times. “The financial rewards are much more for outpatient than inpatient care…” (TheIncidentalEconomist).
So for all this money and all these incentives is outpatient care really all that effective in preventing, treating and managing patient health?
Sources: Center for Disease Control (http://www.cdc.gov/nchs/data/misc/healthcare.pdf); TheIncidentalEconomist (http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-—-outpatient-care/); WebMD (www.webmd.com)