HEALTH AND SOCIAL CARE

Principle Practice in Health and Social Care

Principle Practice in Health and Social Care

It has been almost 15 years since social work researcher Rosalie Kane (2002) accurately predicted many of the changes occurring in health care today. Cautioning that research by others might fail to address problems and services of particular concern to social workers, Kane called on social work to empirically examine its practice by specifying the interventions and outcomes of social work services.

Health Services Research

Services research aims to answer questions about the effectiveness of treatments, interventions, and service delivery mechanisms in actual health care settings and about the impact of organizational and financing mechanisms on the cost, quality, and outcome of health care services.

Recent changes in health care have been propelled by concerns about the rising cost of health care precipitated by changing national demographics and dramatic advances in medical technology. Preoccupation with cost, coupled with failure to marshall the necessary public will to provide health care as a public good, has spurred the current industrialization of health care. As a result, managed care is today's dominant economic and organizational force in health care delivery. Indeed, the managed care movement in this country might be characterized as a giant unplanned natural experiment aimed at reducing health care costs. Results are yet unclear, and little is known about its effects on access to and quality of health care.

Does managed care reduce health care costs (versus which other systems of care)? If so, which costs does it reduce? What outcomes will be assessed? Will adequate, accessible, and quality social services be provided within the general medical and public health care sectors? Will mental health care and substance abuse services be designated (and adequately financed) as essential general health care benefits and services?

To aid them in addressing these primary issues, policymakers, health care administrators, payers, consumers, and the public at large are increasingly demanding research-based evidence of cost-effective services for individual and communitywide health problems. Health services research is likely to be further developed and to be an important element in health policy analysis.

Availability, Access, and Utilization of Health Care Services

Questions about availability, access, and utilization of services for vulnerable populations are likely to rank high on a list of needed research as defined by social workers. (Mechanic, 2010, pp. 45-51; Mechanic, Schlesinger, & McAlpine, 2012, pp. 105-109). At the same time, managed care is rapidly growing in the publicly funded health sector (Freud & Hurley, 2012, pp. 205-207). To begin to address important questions, social work researchers might collaborate with state agencies to monitor and critically analyze utilization data and to develop data-gathering mechanisms and measurement tools for multidimensional outcome assessment. Social workers will want empirical evidence on potential underutilization of services by highly vulnerable groups and on discrimination or preferential selection in managed care enrollment practices or in full access to services.

The types of services and the organizational mechanisms through which services are provided raise further questions of concern to social ...