Emerging as hospitals' most promising source of new patients are clinics like Columbia-Presbyterian Eastside, which, in health care jargon, are called "centers," lest potential patients confuse these gleaming outposts with conventional clinics that cater to the poor and uninsured. To attract middle-class patients wary of leaving their protected blocks, the city's huge hospitals are branching out to ethnic enclaves, upscale New York neighborhoods, affluent suburban communities, and even distant American expatriate communities in Eastern Europe.
Four months ago, Columbia-Presbyterian created a satellite in Moscow and more centers are planned for Warsaw, Prague, St. Petersburg, Budapest, and possibly Beijing.
"Our feeling is that there will be no hospitals in the future," said Dr. William T. Speck, president of Columbia-Presbyterian. "And probably, in the next 10 or 20 years most of the activity will take place in a center or maybe even in homes."
At Columbia-Presbyterian, the top executives are already mulling over what to do with the huge Washington Heights hospital as it empties out to the satellites.
"Hospitals are going to get smaller and smaller and maybe the hospitals might turn into something else," Dr. Speck said. "Perhaps a gymnasium or a flower shop."
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