Peer Perspectives

The Future of Health Care — Expansion of Social Workers for Equitable Practice

By Elizabeth A. Roberts, MSW

The U.S. health care system is plagued with high uninsured rates and unsustainable spending, and there is a lack of emphasis on preventive health solutions and patient-centered care. These dilemmas are negatively affecting the ability to obtain optimal treatment services, continually leading to poor health outcomes. Over the past decade, attempts have been made to resolve these issues through institution of the Affordable Care Act. In spite of this effort, cost, access, and quality remain overarching concerns associated with health care services, preventing an equitable system of care.

It is no secret that our nation’s health care system is the most expensive in the world. Still, many Americans may not be aware that our country is expected to reach an all-time high of nearly $6 trillion in spending within the next eight years (Centers for Medicare & Medicaid Services Office of the Actuary, 2019). Even so, overall health is declining as our society is faced with persistent challenges accessing health care services. There is a strong indication that high spending does not equal access to care and treatment.

Unmistakably, health care costs and lack of access are creating an adverse impact. The outcomes for low-income, ethnically diverse, and older adult populations are even more problematic. The U.S. Department of Health and Human Services Agency for Healthcare Research and Quality confirms there is an unequal balance in the quality of care received across our nation. Quantifiable gaps exist between the levels of care people of color receive in comparison with whites (2018). Another concern is the notable decline in services acquired for treatment of individuals living with mental illness. In 2017, at least two out of five adults living with mental illness did not receive needed services (Substance Abuse and Mental Health Services Administration, 2018). Therefore, data suggest that disparities in services exist for vulnerable populations. Tackling issues of providing socially just care, affordable cost, and reasonable access to quality service will require a practical and sustainable solution.

Diversity, Longevity, and Demand
As our society welcomes greater diversity, the older adult population is also rising in numbers. As a result, the demand for qualified professionals is mounting. Over the next decade, the baby boomer generation (individuals born from 1946–1964) will be 65 years of age and older. In fact, the older adult population is more racially and ethnically diverse than ever before. Approximately 10 years from now, 21 million older adults will be of a nonwhite ethnic background (Administration for Community Living, 2019). Consequently, a perpetual upsurge for comprehensive health care services has begun. To compound matters, the National Projections for Supply and Demand expects a massive shortage in the health care workforce by 2025 (U.S. Department of Health and Human Services Health Resources and Service Administration, 2016). Ongoing challenges are intensified with these additional service needs.

Achieving Equitable Health Care
Scaling up our current health care system will require the ability to meet present and future needs, with a focus on vulnerable populations that are exposed to even greater barriers to treatment. Health care services must be affordable and accessible. Yet, cost and access alone do not generate health equity. We must acknowledge and apply best practices to support optimal health care, and to aim for this target utilizing social workers is a feasible option. With a social justice and human rights framework, the social work profession employs high ethical values and standards in practice. Since the inception of the profession, social workers have focused on public needs and helping underserved populations access health care. Factoring complete social, economic, and physical contexts into patient assessments and treatment plans is paramount if we are to produce an optimal health care system.

Likewise, social workers perform culturally competent practice in a variety of care settings. Cultural competence is an ongoing pursuit of knowledge and understanding that hones skills to better serve individuals from diverse backgrounds. This aptitude is also essential in the health care field because cultural contexts and worldviews often influence thoughts and behaviors. These factors can impact our health goals and treatment decisions to varying degrees. Patients benefit as it is common practice for social workers to routinely obtain continuing education to heighten expertise in cultural awareness. This is an important qualification if our aim is to improve the patient experience.

Future of Health Care
In a nutshell, social workers are a viable resource and can provide a practical remedy to the challenge of delivering an equitable health care system. Due to the unique skill set held by social workers, they are able to facilitate the patient assessment process, pinpoint health concerns that may be considered atypical, and provide a continuum of care across the lifespan. This type of proficiency allows for fluidity and a streamlined process to help decrease spending and increase access to quality services.

Over the next 10 years, social workers can anticipate being called upon to help meet demands and satisfy foreseeable shortages. Growth in employment opportunities is likely to occur in a number of roles including work on multidisciplinary health care teams in collaboration with other professionals, such as physicians, nurses, and physical therapists. Social workers should expect to become progressively vital to the health care system for comprehensive treatment and preventive solutions. Social workers can look forward to a 19% to 20% increase in employment within the health care and behavioral health services; this percentage of growth is above average compared with all other occupations (Bureau of Labor Statistics, 2019).

— Elizabeth A. Roberts, MSW, is a graduate of the University of Connecticut School of Social Work with concentrations in policy practice and international social work. She has also studied direct practice in schools and performed therapeutic interventions while collaborating on multidisciplinary health care teams.

References
Administration for Community Living. (2019). Minority aging. Retrieved from https://acl.gov/aging-and-disability-in-america/data-and-research/minority-aging.

Bureau of Labor Statistics. (2019). Occupational outlook handbook, social workers. Retrieved from https://www.bls.gov/ooh/com-an-serv/mo/so-w.htm.

Centers for Medicare & Medicaid Services Office of the Actuary. (2019). National healthcare expenditure projections, 2018-2027, forecast summary. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ForecastSummary.pdf.

Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health.

U.S. Department of Health and Human Services Agency for Healthcare Research and Quality. (2018). Overview of quality and access in the U.S. health care system. Retrieved from https://www.ahrq.gov/research/findings/nhqrdr/nhqdr16/overview.html.

U.S. Department of Health and Human Services Health Resources and Service Administration. (2016). National projections of supply and demand for selected behavioral health practitioners: 2013-2025. Retrieved from http://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/behavioral-health2013-2025.pdf.