Outpatient/ Ambulatory Care: Financing and Trends Over Time 

Respond to the following questions by providing a full explanation in the context of outpatient/ambulatory care services. 

1. How and by whom are these services covered by? Include any restrictions & eligibility requirements

• Outpatient or ambulatory care services are covered by a variety of insurance plans, including private health insurance, Medicare, Medicaid, and, in some cases, direct payments by patients. Coverage for outpatient services often has restrictions, such as referral requirements for specialist visits or limitations on the number of covered visits per year. Additionally, insurers may not cover certain treatments or may only provide partial reimbursement for specific services. 

2. What are the trends over time for outpatient/ambulatory care services? Have services expanded or declined? Explain your answer.

• Over time, outpatient or ambulatory care services have generally expanded. It has increased through the use of outpatient services. The growth of Urgent care and retail clinics has also made outpatient care more accessible. Telehealth has also increased during the pandemic because patients were advised to stay home and it increased to have remote follow-ups and consultations. 

3. What impact did the Affordable Care Act (ACA) have on outpatient/ambulatory care settings and services? 

• Outpatient care services have expanded significantly over time, driven by increased utilization, technological advancements, and policy changes such as those introduced by the ACA. These trends reflect a shift towards more accessible, preventive, and coordinated care, enhancing overall patient outcomes and healthcare efficiency.