Infection Control and Changing Health-Care Delivery Systems
In the past, health care was delivered mainly in acute-care facilities. Today, health care is delivered in hospital, outpatient, transitional care, long-term care, rehabilitative care, home, and private office settings. Measures to reduce health-care costs include decreasing the number of hospitals and the length of patient stays, increasing outpatient and home care, and increasing long-term care for the elderly. The home-care industry and managed care have become major providers of health care. The role of specialists in health-care epidemiology has changed accordingly.

Over the past two decades, there has been a revolution in health-care delivery systems in the United States. The number of acute-care facilities has decreased, the proportion of patients requiring intensive care in acute-care facilities has increased, and the number of surgical procedures performed in outpatient settings or surgical centers has increased. Not only has there been a shift to the outpatient setting, but the long-term care, home-care, and managed-care industries have grown dramatically. I will provide an overview of recent changes in the U.S. health-care delivery system and describe the challenges for health-care epidemiology and infection control departments in the new millennium.