Chapter 6: Social Work in Health Care

Medical Social Work Values Recognition of individual dignity and worth (respect) Recognition and acceptance of cultural diversity (cultural competence) The right of people to lead/actively participate in the helping process (empowerment)

Medical Social Work Values The right of clients to make decisions about things that will affect them (self-determination). Social work as a profession supports the human right of universal access to quality medical care.

Social Work Roles in Medical Settings Advocacy Patient Education Support to patients and families Crisis Intervention Discharge Planning

Medical Social Work Settings Hospitals Acute Care and Sub-acute Care Facilities Long-term Care/Nursing Homes Home Health Care/Hospice Programs Primary Care/Outpatient Clinics HMOs and Insurance Companies

Medicare and Medicaid: The original government-funded health care programs Created in 1965 by an amendment to the Social Security Act. Responded to nationwide pressure to provide some form of national healthcare to populations at risk, especially elders, people with disabilities, extremely poor people.

Medicare Medical care for the elderly and disabled. Covers over 43 million Americans Social insurance program (universal, non-means-tested) paid for out of revenues from payroll deductions Only available to people who have paid into Social Security/Medicare (almost all workers and their survivors)

Medicare has four parts: Part A covers hospitalization and a certain number of days in a nursing home. Part B provides outpatient services, doctor’s visits, laboratory services, outpatient psychotherapy, etc. Part C provides managed-care coverage but has high deductibles Part D provides some prescription drugs coverage but has a “donut hole”

** Medicare plans have caps and do not cover long-term nursing care, dental services, eyeglasses, and most prescription drugs. **

Medicaid Public Assistance (means-tested program) paid for out of general tax revenues covers over 58 million Americans, including people who receive SSI (Supplemental Security Income) due to blindness, age, or disability, as well a pregnant women and children with a family income below 133% of the poverty line.

Medicaid Over 70% of Medicaid recipients are children, yet children use less than 20% of Medicaid Funds because it is frequently used to pay for nursing homes for the elderly. SCHIP is a plan that provides near universal coverage for children

Financing Health Care Due to high costs, overspending, and provider fraud, two payment plans evolved (initially for Medicare but now used in most insurance plans: Diagnostic Related Group Plan (DRG) – Provided payment to hospitals based on a dollar amount per diagnosis. Prospective Payment System (PPS) – Current system used to cut costs. Hospitals are paid a certain amount according to the patient’s diagnosis. If patients are discharged early the hospital makes a profit, if the patient stays longer than expected the hospital loses money.

Health Care Reform Universal Coverage – Every person would receive health care benefits at the same rate regardless of their economic status. All industrialized countries have universal coverage, except the United States. Single-Payer System – Either the government or a single private corporation selected by the government administers the insurance program.

Countries with universal coverage have one of two approaches: National insurance approaches offer insurance or a guarantee of coverage through either a government or privately run insurance plan that pays for health care using private providers National health services are government owned and government-administered health care facilities. Doctors and other health care providers work for and are paid by the government

Cost-benefit analysis Due to for-profit status and higher administrative costs, health care is much more expensive when paid for by private insurance companies Benefits: People with good private-pay insurance may get medical care more quickly and may get more access to advanced technologies than people who participate in single-payer systems Consequences: People in countries without universal coverage may lack access to care and often resort to using emergency rooms when they are extremely ill, driving up costs and creating longer waits for everyone else Overall, people are healthier and live longer in countries with universal coverage

U.S.A. vs. Japan U.S.-Individual Coverage Health Care expenses are 15.2% of GNP 7/1000 babies die each year Average male expects to live to age 75 Average female expects to live to age 80 Japan-Universal Coverage Health Care expenses are 7.9% of GNP 3/1000 babies die each year Average male expects to live to age 78 Average female expects to live to age 85