The walk-in chains: the proprietarization of ambulatory care.

In this article we examine the previously little-studied development in U.S. health care--the growth of a proprietary ambulatory care system composed of health maintenance organization, urgent care centers, ambulatory surgicenters, ambulatory diagnostic centers, large group practices, and other delivery modalities. The growth of this system as a result of the ease of access to capital, limited or nonexistent regulation through Certificate of Need or other mechanisms, the growing surplus of physicians, decreases in the use of hospitals as a result of changed insurance benefits and inpatient utilization review, new developments in biotechnology, and computerization and miniaturization of new technological advances is discussed. The reasons for the expanded growth of proprietary chains over nonprofit systems of ambulatory care are also discussed. The article concludes with a discussion of the negative consequences for individual health and the health care system that may be generated by the continued growth of proprietary ambulatory care.