Hospitals Lose Ground as Ambulatory Clinics Expand

New data show U.S. ambulatory surgery centers added 140 net facilities in 2024, while Medicare policy changes in 2026 are widening the set of procedures clinics can perform. The shift underscores how outpatient care is pulling demand away from traditional hospitals and creating room for smaller, focused operators.

Why it matters: - The healthcare growth story is shifting from large hospitals to smaller outpatient and specialty clinics. - That change opens a lower-cost entry point for founders and operators that can finance and launch a clinic without building a full general hospital. - The trend also matters to investors and health systems because more care is moving to day and outpatient settings.

What happened: - In the United States, 248 new ambulatory surgery centres opened in 2024, while 108 closed or merged. - The net gain was 140 centres, bringing the total to 6,436 Medicare-certified ambulatory surgery centres, according to the Medicare Payment Advisory Commission's March 2026 report to Congress. - More than 95% of U.S. ambulatory surgery centres are for-profit businesses. - The number of centres has risen every year since 2019. - Medicare began phasing out its inpatient-only list on 1 January 2026. - In the first step of that three-year phase-out, 271 procedure codes moved onto the ambulatory surgery covered list. - Medicare also added 276 more procedures under revised criteria. - Georgia and North Carolina have rolled back certificate-of-need rules that had limited where new clinics could open.

The details: - eFinancialModels' USA Healthcare and Hospital Market Study says outpatient care made up 57% of U.S. hospital net patient revenue in 2024. - The same study projects that outpatient care will rise to 64% by 2031 in its base case. - In Australia, 75% of private hospitalisations were same-day in 2024-25, compared with 56% in public hospitals, according to the Australian Institute of Health and Welfare. - eFinancialModels reads both figures as evidence that hospitals are shifting more of their own activity into day and outpatient work. - In Germany, Destatis' latest population projection shows one in four people will be aged 67 or older by 2035, up from one in five in 2024, across every variant of the projection. - eFinancialModels identifies long-term care as the secular demand driver in its Germany study. - The company says the market opening differs by country: ambulatory surgery in the United States, fertility and specialist clinics in the United Kingdom, and Tier-2 and Tier-3 cities in India.

Between the lines: - The core shift is not just more demand. It is demand moving into settings that can be built, staffed and financed at a smaller scale. - That favors operators who can model payer mix, reimbursement timing, fit-out cost and break-even timing before opening. - The same trend also suggests traditional hospitals may keep losing profitable outpatient volume to standalone sites.

What's next: - eFinancialModels says the seven market studies behind the release cover the United States, United Kingdom, Germany, Australia, Singapore, India and Brazil. - The company says the studies are free to download, alongside clinic and healthcare financial model templates for founders building their own numbers. - Future openings will likely depend on which niches have the strongest economics and whether local rules allow new clinics to launch.

The bottom line: - Healthcare growth is increasingly favoring focused outpatient clinics over full-service hospitals, and the next winners will be the operators that can prove the numbers before they build.