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In a study of 300 chronically ill patients who were referred from an outpatient department to community health centers in a public hospital district, we found that the number of visits made, the amount of medicine prescribed, and the number of tests ordered all increased markedly for those patients in the 6 months immediately following their referral. As a result, there was substantial increase in the charges incurred for their care. The care itself changed as well. The physicians at the centers on the whole differed from those at the hospital in the emphasis they placed upon various types of visits, medicines, and tests. There were also large differences among the community health centers along these dimensions. The findings indicate the difficulty of providing comparable care at a comparable cost within a large health care system.

The process of ambulatory care: a comparison of the hospital and the community health center.