The reform of ambulatory care: a financial paradox.

The purpose of this paper is to examine the financial factors which have effectively constrained the movement toward major reform in the out-of-hospital medical care area within this country. Analysis of the current economic picture in the health field leads inescapably to the conclusion that the major wave of new out-of-hospital programs predicted in the early 1970s is not likely to occur in the immediate future. The financial constraints are so substantial that the expansion of new forms of delivering ambulatory care services (HMOs, restructured OPDs, neighborhood health centers, etc.) into low- and moderate-income communities will proceed more slowly than was originally anticipated. The facts outlined in this paper clearly indicate that many new ambulatory care projects designed to serve low- and moderate-income people will face serious financial difficulties and will place a heavy burden on the resources of sponsoring institutions. In the future, widespread reform in the out-of-hospital area will await major improvements in the way this country finances its ambulatory care services.