Five years ago a new administration stepped forward to design a comprehensive health care
reform initiative. At the time, the administration suggested that the federal government
build on prototypical "managed care" models, creating an efficient yet equitable
public health care system. Congress subsequently fumbled its opportunity to guide the
evolution of the new system. Thus, managed care swept with unprecedented speed through our
institutions, our medical community, and our work places. A radical, historic shift in
society’s health care process took place before our astonished eyes, driven totally
by market forces and entirely outside regulatory management.
Deep within the maelstrom, America’s social workers have been
riding the tide of overpowering change. In every setting—hospitals, research
institutions, nursing homes, community mental health centers, clinics, schools, private
practices, managed care companies—social workers are on the front lines of health
care delivery as the nation’s largest groups of mental health care providers. Like
the canary in the coal mine, the social work profession’s fate is a telling indicator
of our nation’s well-being in the face of the massive conversion to managed care.
Social workers historically have been at the forefront of social
change. For 100 years, professional social workers have been addressing the needs of the
poor and advocating for improved social conditions. Consequently, it is not surprising
that they are once again in the vanguard, assessing the impact of managed care.
Humane Managed Care?—a collaborative effort of Smith College
School for Social Work and the National Association of Social Workers—is a compendium
of up-to-date research, analysis, experience, and evaluation of this impact on social
workers and their clients.
We are confident that our multidisciplinary, wide-ranging review of
this phenomenon not only will inform, but also will stimulate an ongoing public policy
debate on a crucial topic. By replacing the spiraling costs of a flawed health care system
with what appear to be spiraling profits at the expense of quality, what exactly has
managed care brought us? How can social workers and other health care professionals
"thrive with honor" as they adjust their practices and practice education in
response to its demands? This book gives us a framework and the knowledge for examining
complex issues and provides a basis for finding a solution.
Those who embrace the responsibility for being change agents will
discover effective and ethical responses to managed care. The market-driven care system
must be required to adhere to fundamental principles that provide for consumer voice,
consumer choice, and service to America’s most vulnerable populations. Passage and
implementation of a consumers’ bill of rights will be a beginning. Regulatory
legislation and administrative procedures may be next. But one thing is essential—the
continued vigilance and involvement of those committed to equitable social welfare.
Josephine Nieves, MSW, PhD
Executive Director
National Association of Social Workers
Washington, DC
Return to Humane Managed Care? |
