Policy changes and their possible impact on hospital-based ambulatory care.

Hospital-based ambulatory care has been an important source of medical care, and most particularly so in New York City. In 1982, there were a total of 10,629,035 visits to outpatient clinics and emergency rooms. In the present climate, there is pressure to shrink numbers of acute care beds, reduced Medicare reimbursement for graduate medical education, and withdraw payment for foreign medical graduates. The hospital by-product of ambulatory care will surely change as hospitals deal with survival in competition for the inpatient market.