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Privatization  

Andrew Dobelstein

Privatizing social services has taken a new turn as America enters the 21st century. Although it was once possible to separate private and public social services, the growing trend toward public–private partnerships has made such earlier distinctions meaningless since more and more private social services are supported with public money. There are advantages and disadvantages inherent in the mixing of public and private social services, but perhaps the greatest problem may be the support of a growing trend for all levels of government to dissociate themselves from their longstanding public social service responsibilities.

Article

Neoliberal Managerialism and the Human Services  

Mimi Abramovitz and Jennifer Zelnick

Neoliberalism emerged in the United States in the mid-1970s in response to the second economic crisis of the 20th century. Seeking to undo the New Deal enacted in response to the 1930s economic collapse, neoliberalism redistributes income upward and downsizes the state using tax cuts, budget cuts, privatization, devolution, and reducing the power of social movements. Privatization, a key neoliberal strategy, is typically understood as shifting responsibility for entitlement programs such as Social Security or Medicare from public to the private sector. Managerialism (i.e., the adoption of business principle and practices) refers to operationalization privatization within human service agencies. The growing dominance of managerialist productivity, accountability efficiency, and standardization has redefined the landscape of the human services The troubling impact on service provision, working conditions, and the well-being of human service workers leads us to ask if the social work mission will become a casualty of managerialism.

Article

Health Care Financing  

Candyce S. Berger

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.

Article

Corporate Settings  

David Stoesz and Catherine Born

For-profit health and human service corporations afford a range of employment opportunities for professional social workers, although organizational structures may not resemble those of nonprofit and government agencies, and these settings may present new professional challenges. Corporations have become prominent, in some cases dominant, providers in fields as disparate as hospital management and nursing home care, child and adult daycare, residential treatment, managed health care, welfare eligibility and job placement, child support, and corrections. For-profit expansion across the array of health and human services continues, which bodes well for social workers willing to consider corporations as a practice setting. Opponents of commercial human services worry that adverse client selection criteria may screen out the most troubled individuals and about possible corner-cutting in service delivery to meet fiscal targets. The general concern is that, in these firms, profit may trump program. Others strongly believe that the profit motive is simply incompatible with the human service mission. Proponents claim that benefits include management and cost efficiencies, nimbleness, ease and speed of innovation, and technological prowess. The emergence of new commercial entities such as benefit corporations that commit to creating social benefit, not just profit, are also touted. Arguments aside, the neoliberal social policy vector that emerged in the later decades of the 20th century encourages the outsourcing of public services. Thus, privatization in the form of corporate human services may continue to expand and almost certainly will continue to exert influence in health and human services policy, programming, and service delivery for the foreseeable future.