Historically, health services for the ambulatory patient have been organized throughout the world along several paths: (1) separate dispensaries for treatment of the sick, (2) hospital outpatient departments, (3) specialized preventive clinics under public health agencies, industries, or schools, (4) private group medical practice, and (5) health centers of either preventive or integrated preventive-curative scope. All five of these types of organized service continue to expand throughout the world, in relation to a declining importance of private individualistic medical practice. The trend is toward integrated ambulatory service for both preventive and curative services in health centers. The staffing and scope of health centers vary with the economic development of a country and its prevailing political philosophy. As a result of dialectical dynamics between hospitals and ambulatory care centers, these two types of service are becoming integrated in regionalized networks, increasingly supported by funds from collective sources (both taxation and insurance) and designed through national health planning. Increasing use is being made of paramedical personnel working with doctors in health teams.
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