This dissertation examines how financial incentives and regulatory changes shape provider behavior, healthcare productivity, and patient access in surgical care delivery. I study these dynamics in the context of the ongoing shift of procedures from inpatient hospital care to lower-cost outpatient alternatives, including Hospital Outpatient Departments (HOPDs) and Ambulatory Surgery Centers (ASCs). Amid rising healthcare costs, this migration has gained momentum, with the Centers for Medicare and Medicaid Services (CMS) expanding the roster of surgical procedures eligible for outpatient settings each year. I analyze the impacts of this transformation in three chapters. First, I study the outpatient expansion of total knee replacement using a difference-in-differences design. I find that this change led to substantial Medicare savings without compromising quality for treated patients, but reduced access for higher-risk and underserved populations—particularly at capacity-constrained non-profit hospitals. Second, I estimate the productivity effects of ASCs relative to HOPDs with an instrumental variables (IV) analysis. I document lower spending and comparable quality at ASCs, with state-level regulations shaping both adoption and impact. Lastly, I describe changes in surgical care delivery following the COVID-19 pandemic. I identify sustained shifts toward outpatient settings alongside emerging socioeconomic disparities in access, as well as limited changes in patient cost-sharing despite lower overall costs. Together these findings demonstrate that while the outpatient migration of procedures can generate meaningful efficiency gains, it may also exacerbate disparities, underscoring the need for policy frameworks that balance cost containment with equitable access.