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UA SW 200 - Chapter 7: Health Care and Health Challenges

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Chapter 7: Health Care and Health ChallengesChapter 8: Physical, Cognitive, and Developmental ChallengesChapter 9: Mental HealthChapter 10: Substance Use and AddictionChapter 11: Helping Older AdultsLecture NotesChapter 7: Health Care and Health ChallengesOutlineI. Health Challenges and the American Health Care SystemA. Some Basics1. Health: A state of complete social, mental, and physical well-being2. Illness: A disease or period of sickness impacting the body or mind3. Health is more than just the absence of illness4. Health depends on social and environmental factors as well as biology and lifestyle5. Among high-income countries, the United States is worst in many health-related areasa) Infant mortalityb) Heart and lung diseasec) Adolescent pregnanciesd) Homicidese) Disabilitiesf) Sexually transmitted infections6. Still, the United States has gained 30 years in life expectancy over the last centuryB. Threats to Americans’ Health1. Chronic Illnessa) Causes about 70% of deathsb) Results in reduced quality of lifec) Many such diseases are preventable with lifestyle changesd) Less advantaged people experience more chronic illnesses due to structural and environmental factorse) Social workers can assist people in learning about their conditions and accessing resources to help them manage those conditions2. Heart Diseasea) Two-thirds of Americans will die of heart diseaseb) Includes angina, coronary heart disease, and congestive/congenital heart failurec) 715,000 heart attacks per year in Americad) Highest in South, lowest in Weste) #1 or #2 cause of death for every racef) Social workers can help educate people about the signs of a heart attack3. Stressa) Stress is our response to change, and can be healthy or unhealthyb) Can impact a person’s thoughts, feelings, mood, bodyc) Eventually can harm sleep patterns and overall health, leading to chronic diseasesd) Social workers can help people develop stress management skillsC. Health Disparities and the Uninsured1. Health disparities are gaps between population groups in key health dataa) Availability and quality of careb) Disease rates and severityc) Overall health2. Whites have better health status and outcomes than other groups in the United States3. Poorer people and LGBTQ+ individuals have lower health status/outcomes4. Differences in ability to access health care are a major cause of disparitiesD. Health Care Policy in the United States1. Health insurancea) Insurance is now essentially required in order to access quality health careb) HIPAA (Health Insurance Portability and Accountability Act)c) Medicare Part D: Prescription coverage, passed in 2007 under Bushd) Most citizens covered by private insurance under a family membere) Many government insurance options like Medicaid, CHIP, Medicaref) Insured people may be limited in provider choice by health networks2. Affordable Care Act (2010)a) Expanded public health options like Medicaidb) Insurance companies cannot deny coverage due to preexisting conditionsc) Young adults can remain on parents’ insurance until age 26d) Yearly limits on coverage are barrede) Individual mandate: must pay tax penalty if you don’t have insurancef) Subsidies exist to help lower-income people afford insuranceg) Potential changes in the system(1) Repealing and replacing ACA(2) Changes in physicians’ payments under Medicaid/Medicare(3) Continued interest in treating rare diseases through medication(4) Mental health care integration into health care(5) Emerging care models seeking to lower middleman-induced costs(6) High-value care in alternative sites to hospitals(7) Biosimilar drugs(8) Continued searches for improved cancer care(9) Payer changes as prescription drug use increases(10) Technological innovations and the FDA approval processE. Health Care Trends1. Continuous quality improvement2. Integrative medicinea) Seeing the patient’s health holistically--body, mind, spiritb) Natural and less-invasive treatments used when possiblec) Partnership between patient and providerd) Conventional and alternative methods supportede) Social workers needed to help people navigate the healthcare process3. Slow medicinea) A more deliberate approach to determining best treatment optionsb) A plan for living well and fully in the time an older patient has left4. Prevention and Wellnessa) Often easier to prevent illness than to treat itb) Encouraging healthy lifestyles and proactive healthcare5. Recovery, Rehabilitation, and Resiliencea) Social workers can help patients reduce risk factors, increase protective factorsb) Aim to increase resilience: a patient’s ability to ‘bounce back’ from difficulties6. Inflammationa) Acute inflammation occurs in immediate or short-term aftermath of a disease, with symptoms designated by PRISH (pain, redness, immobility, swelling, heat)b) Chronic inflammation lasts for months/years as a result of autoimmune disease, chronic irritant, or prolonged presence of a particular cause7. Managed Carea) HMOs (health maintenance organizations) designate gatekeeper primary care doctors who may refer patients to specialists when needed; HMO patients pay lower premiums and co-paysb) PPOs (preferred provider organizations) may not require co-pays, but have a deductible; these are lower-cost plans overallc) Managed care organizations have varied pros and cons8. Electronic Medical Records (EMRs)a) Computer-based records with history, lab results, and so onb) Electronic health records (EHRs) allow results to transfer from provider to providerII. Health Care and Social WorkA. History of Health Social Work1. Social workers have long helped people cope with acute illness and terminal illness2. Health social workers are part of an interdisciplinary team and must be familiar with medical concerns3. 1905 at Boston Massachusetts General Hospital--first medical social worker4. First subset of social workers to organize as professionals5. Engage in support and advocacy for patients in medical system6. Also educate community about health issues and advocate for safer, more health-supportive living conditionsB. Social Workers’ Role in Health Care Practice1. Ensure high-quality, family/client-centered care2. Advocate for clients’ rights, self-determination, informed consent, confidentiality3. Encourage social work involvement in developing/implementing best practices4. Encourage participation in policy development regarding health care5. Educate policymakers and public about social work’s


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