Because hospitalization accounts for 80 percent of the health care bill and because hospitalization costs are so high, the medical profession has developed a series of alternatives to hospital care. The alternatives include expanded outpatient clinics, chronic care facilities, home care programs, and hospice programs. Although the motivation for these changes has been economic, the result has been humane: most people prefer almost any health care setting to a hospital. Expanded Outpatient Facilities-Outpatient facilities—physicians’ offices, clinics, or specialized facilities—now offer many of the procedures and treatments that previously required hospitalization. Examples of these procedures and treatments include blood transfusions, some intravenous treatments, specialized diagnostic examinations like CAT scans or MRI scans, endoscopy, induced sputum tests to diagnose Pneumocystis pneumonia, and most minor surgical procedures. The biggest reason that outpatient facilities have expanded their services is cost: treatments done on an outpatient basis are substantially less expensive than those done in a hospital. Another reason that outpatient facilities have expanded is that insurers will not reimburse people who are only admitted to the hospital to get some types of treatments and procedures. And to make things more confusing, some insurers now reimburse only those treatments done in a hospital. The contradiction in reimbursement rules is difficult to understand but important to know about. Talk to your insurance company, your social worker, and your physician. It may be that the test you need will cost more to do in the hospital, but the final bill to you will still be less.*171\191\2*
