Alternative forms of ambulatory care: implications for patients and physicians

In recent years, new providers of ambulatory health care have appeared in the U.S. These providers are characterized by an emphasis on profit making, where the primary care giver, the physician, is often an employee, and where patients receive care in a non-traditional setting. Examples of these alternative providers include for-profit Health Maintenance Organizations (HMOs), freestanding ambulatory care centers (walk-in clinics), and outpatient surgery centers. These and other alternative suppliers of health care are of interest since they represent a new and growing form of health care delivery. For many patients, alternative providers of ambulatory care offer convenient, cost-effective medical service. However, the emphasis on profit which characterizes most of these providers may mean that rural, and inner city areas, as well as the poor and uninsured throughout the country, will not be able to take advantage of the convenience and savings these providers offer. For physicians, employment in an alternative ambulatory care system can be welcome as the costs of starting and operating a medical practice soar. Yet, physician-employees often face loss of autonomy, status and income. Authors point to the 'proletarianization' of physician-employees as they lose control over the location, means and direction of their work. This paper explores the development of alternative suppliers of health care. It focuses on three providers of alternative ambulatory care and the implications of these providers for both patients and physicians. Proposed directions for future research include obtaining data on the actual extent of alternative providers in the health care market and their effects on consumers and the deliverers of medical care.