1. Chapter 6: Social Work in Health Care

2. 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)

3. 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.

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

5. 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

6. 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.

7. 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)

8. 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”

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

10. 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.

11. 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

12. 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.

13. 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.

14. 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

15. 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

16. 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