p.p1 hospital. According to Shi and Singh

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There are many ways to compare inpatient care and ambulatory care.  A few important topics of comparison is the scope and level of service, venues for care delivery, the impact on health care finance, and future trends in medicine and care delivery.
    Ambulatory care is medical care provided to the “ambulatory” or walking patient. Even though the care is outpatient, it can still be located within a hospital.  According to Shi and Singh (2017) they’re “broadly classified into five main types: clinical (typically for the uninsured or those participating in research studies), surgical (patients are discharged on the day of surgery), home health care (postacute care and rehabilitation), women’s health and traditional emergency care” (p. 173).  The ambulatory care can also found as freestanding facilities (urgent care, walk-in, and surgicenters), mobile facilities for medical, diagnostic and screening services (medical staff go into the community to offer routine care), telephone triage (usually nurses answering after hours calls), community health centers (for medically underserved) and free clinics (non-government funded), and alternative medicine clinics (homeopathic, acupuncture), home health (short term rehab, dressing changes), hospice (pain management and palliative) and long-term care (adult day care, case management).
Inpatient care, in contrast to ambulatory/outpatient care, refers to staying the night in a hospital or nursing home.  There are several types of hospitals.  Specialty hospitals treat specific diseases or conditions such as orthopedic, cardiac and oncology.  There are also psychiatric hospitals that serve patients with mental illness, rehabilitation hospitals for physical, occupational, speech and language therapies.  The children’s hospitals treat a large variety of acute and chronic illnesses and diseases including Cystic Fibrosis, which is what my daughter was born with.  Nursing homes are the other inpatient facility.
There are three levels (primary, secondary and tertiary) of care that are determined by the length, frequency, and level of intensity.  There are two levels of care that fall within the ambulatory setting.  The first is primary care which is considered to be basic and routine services.  These services include annual checkups, broken bones, rashes, sick from a virus or bacterial infection.  They coordinate care with specialists when the patient needs to be referred.  Examples of PCP (primary care providers) would be physicians, nurses, nurse practitioners and physician assistants.  There is also primary care “specialists” which include OB-GYNs, geriatrics, and pediatricians.  They are only considered specialists because they deal with a certain group of people (Torrey, 2017).  The specialists that are being referred to by the PCPs are part of the secondary care.  These consist of specialties like cardiology, pulmonology, and neurology (Torrey, 2017).  Routine surgeries and rehabilitation are also part of the secondary care.  Tertiary care is even more specialized than secondary and requires more technologically advanced equipment.  Examples of tertiary include coronary artery bypass surgery, dialysis, plastic and neurosurgeries (Torrey, 2017).  Small hospitals probably wouldn’t have the necessary equipment or staff to support tertiary care.    
Shi & Singh (2017) state that starting in the late 1800s to early 1900s there was a rise in the number of jobs at hospitals.  This was due to the advances in technology, surgical techniques and additional professional training of medical personnel.  Hospitals also began to service individuals in society other than the poor (p. 195).  As patients were able to afford the costs, the hospitals attracted individuals other than the poor.  Hospital growth increased as a result.  
As hospital costs increased, the care became unaffordable for patients.  In 1983, the Social Security Amendment became enacted.  Due to the amendment, hospitals only received set rates (Shi & Singh, 2017, p. 195).  The fixed rates caused Hospital profits to decrease causing them to take action in order to avoid lost revenues.  They ultimately had to cut operation costs and discharged patients faster to free up beds for new patients.  Many hospitals were forced to close because of the fixed rates from the Social Security Amendment.  As a result, hospitals needed to recoup costs and were able to with outpatient clinics.       
Health care will continue to shift in the direction of outpatient due to the lesser costs when in comparison with inpatient.  According to Shi & Singh (2017), inpatient hospital stays are being discouraged by different payers (p. 171).  Technology plays a role in the shift as well.  Cutting-edge technology allows for less invasive surgeries and procedures which makes it possible to do outpatient or cut down the length of hospital stay when an inpatient stay is required.  According to Evans (2017), Hospitals are actively investing in outpatient centers and clinics like surgicenters, ERs, urgent cares and walk-in clinics.  Since patients continually seek convenience and less expensive, these facilities are ideal.  Satellite clinics are strategically placed “closer to where patients live and work” (Evans, 2017).  Essentially, the hospitals are following the patients instead of the other way around.  Hospitals have found a way to adapt to the increase in the use of outpatient facilities.  Ultimately, there is an inverse correlation between inpatient and outpatient facilities revenue.  As outpatient facilities thrive and profits and usability increase, inpatient hospital beds are slower to fill and revenues decrease.
  Payers will continually pressure providers to decrease costs, while medical care costs will continue to increase.  According to Jacobs (2017), telemedicine will continue to be used, for rural areas and patients who don’t want to leave their home.  There will also be a continual advancement in medical science and technology.  Pharmacy costs will continue to rise both inpatient and outpatient.  Jacobs (2017) states that “behavioral health will also come into increasing focus because individuals with mental health disorders often have higher medical costs and greater use of the emergency departments”.    

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References 
Evans, M. (2017, September). Warding Off Decline, Hospitals Invest in Outpatient Clinics.
https://www.wsj.com/articles/warding-off-decline-hospitals-invest-in-outpatient- 
clinics-1506331804        
Jacobs, L.P. (2017, January). 10 health care trends for 2017. 
https://www.trusteemag.com/articles/1184-10-health-care-trends-for-2017
Torrey, T. (2017, November). Understanding the Different Levels of Medical Care. 
https://www.verywell.com/primary-secondary-tertiary-and-quaternary-care-2615354

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