Health Care and Illness

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.

This entry presents an overview of national health-care reform in the United States, from its introduction into the public policy agenda at the turn of the 20th century through policy debates and legislative proposals more than a century later. Specifically, it concentrates on the programs and strategies to obtain universal coverage for health and mental-health services for all Americans at the national level, with limited success. It ends with a discussion of the Affordable Care Act (ACA). Special emphasis is laid on the roles of social workers and their professional organizations during this period.

In social work, social capital is linked to both the prevention and treatment of mental and physical health. This concept has also been incorporated in the development of empowering interventions with marginalized minorities. The capacity-based and the youth development models of intervention, both call on social service organizations to work interdependently around meeting the needs for the human and social capital growth of youth (Morrison, Alcorn, & Nelums 1997). Social capital is also a feature of empowering interventions in neighborhoods and community development, as is collective efficacy, which is a measure of working trust that exists among residents and has been popularized as a way to stop youth high-risk behavior.