The U.S. health care system is a pluralistic, market-based approach that incorporates various public and private payers and providers. Passage of Medicare and Medicaid, combined with rapid advances in technology and an aging population, has contributed to rising health care costs that typically increase faster than general inflation. This entry will review health care financing, exploring where the money is spent, who pays for health care, what the reimbursement mechanisms for providers are, and some issues central to the discussion of reform of health care financing. To effectively advocate health care reform, social workers must understand health care financing.
Candyce S. Berger
Victoria M. Rizzo, Sojeong Lee, and Rebekah Kukowski
In 1965, Titles XVIII and XIX of the Social Security Act were passed, creating Medicare and Medicaid and laying the foundation for U.S. healthcare policy. Originally, Medicare was created to meet the specific medical needs of adults aged 65 and older. In 2022, individuals with end-stage renal disease, amyotrophic lateral sclerosis (ALS), and other disabilities may also receive Medicare, regardless of age. Medicaid was established to provide a basic level of medical care to specific categories of people who are poor, including pregnant women, children, and the aged. As of 2010 as part of the Affordable Care Act (ACA), states are provided with the opportunity to expand Medicaid to close the coverage gap for public health insurance. This entry provides explanations of Medicaid and Medicare and associated social healthcare programs in the United States. An overview of significant programming developments and trends, future directions, challenges, and controversies as of 2021 are also provided.
Bruce Friedman and Rosario Olivera
The field of social work transformed over time from providing relief to less fortunate individuals to a sophisticated profession that looks at evidence-based measures to deliver change. This has been possible by looking at accountability aspects to demonstrate improvement by addressing performance outcomes resulting from interventions. Outcomes operate on all levels from micro to mezzo to macro, and the skills needed include identifying who is being served and the specific goals to be achieved. This article introduces the use of a logic model as a way to explain interventions and outcomes on a short-term, intermediate term, and long-term basis. The section also describes current measures being used to demonstrate how outcomes are used to justify the practice.
Rosalyn M. Bertram
For more than two decades, academic professional degree programs, as well as behavioral health, education, public health and social services have grappled with how to integrate the emerging science of implementation and evidence-based programs, policies or practices into their organizations and systems. During these initial decades of the 21st century, peer-reviewed journals such as Implementation Science, Implementation Research and Practice, and Global Implementation Research and Applications were established. Concurrently, special issues or sections of other journals are also adding to our knowledge of policy and program implementation as was as of academic program preparation and organizational development of a workforce versed in the implementation of effective, sustainable programs or practices. A recent study of this explosion of peer-reviewed outlets was published in Frontiers in Public Health. Organizations such as the Society of Implementation Research Collaboration and the Global Implementation Society offer international conferences as venues for interdisciplinary exploration and development of the science and practice of sound, sustainable implementation of effective policies, programs, or practices. Registries of evidence-based or supported programs are provided by Blueprints for Health Youth Development, the California Evidence Based Clearinghouse for Child Welfare, The National Child Traumatic Stress Network, the Office of Juvenile Justice and Delinquency Prevention, the Title IV-E Prevention Services Clearinghouse, and others. Guidance on program or practice selection implementation can be found through websites maintained by the Active Implementation Research Network, the Child and Family Evidence-Based Practice Consortium, the Franklin Porter Graham Child Development Institute’s National Implementation Research Network, the University of Maryland School of Social Work’s Institute for Innovation and Implementation and many other organizations.