Social workers have long known and been vocal advocates that their services are not just another expense in the healthcare system, but rather spending funds on social work services both decreases overall healthcare costs and improves outcomes for patients. The rest of the world and various healthcare systems are finally starting to take notice of the multiple benefits of providing social work services to patients and caregivers.
This guide covers the current state of healthcare spending and what medical care looks like when social determinants of health are not addressed. In addition, the critical services that social workers provide, along with case studies of their effectiveness for different populations, are discussed.
Finally, guidance is provided for those considering working in medical social work, for programs, courses, and training that can be considered to boost skills and experience and improve the likelihood of being able to work in this challenging yet extremely rewarding specialization of social work.
In this guide- Healthcare costs
- Social determinants
- Social work and health
- Patients and families
- Reducing costs
- Case studies and research
- Become a medical social worker
- References
Healthcare costs in the United States
The United States spends more per person on healthcare than most other industrialized countries. The U.S. spends almost $9,000 per person each year, which is the equivalent of almost 17 percent of the Gross Domestic Product (GDP). However, there is a poor return on investment. The infant mortality rate is high for industrialized nations and overall life expectancy in the US ranks 27th out of 34 industrialized nations that are members of the Organisation for Economic Co-operation and Development (OECD).
One of the biggest reasons for the disparity between the United States and the other industrialized nations mentioned above is the drastic difference in amounts spent on social determinants of health. OECD nations on average spend $2 on social services for every dollar spent on health care.
The United States only spends 55 cents on social services for every dollar of healthcare spending. What we as a nation are just beginning to recognize is the value of providing social services as they drastically affect the health conditions and outcomes of our population.
What are social determinants of health?
According to the World Health Organization, social determinants of health are “the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.”
Inequities in these social determinants of health lead to drastic differences in health status. Those with strong social determinants of health, such as high education, income and access to care in general fare much better than those in lower socioeconomic positions, who suffer worse health conditions and outcomes.
Some examples of social determinants of health include:
- Education
- Working conditions
- Income
- Job insecurity or unemployment
- Food insecurity
- Discrimination
- Safe, clean housing and water
- Access to quality and affordable healthcare
How social work addresses social determinants of health
Social work is a field focused on speaking out against and resolving inequities and supporting the most vulnerable populations. We advocate for and strive to ensure everyone has access to education, safe housing, clean water, affordable, healthy food options and access to quality care that does not discriminate. We work to change policies and systems that are oppressive and/or discriminatory.
We are confronted daily with how lack of access to the above can hinder our clients and communities. Regardless of the particular population a social worker serves, these social determinants can dramatically affect a clients’ physical and mental health.
How medical social workers help patients and their families
Medical social workers work within healthcare systems, such as clinics or hospitals to assess patients and recommend psychosocial interventions to assist with whatever health concern they are experiencing. This may come in the form of disease or condition education to the patient and family, finding devices or adaptive equipment including wheelchairs or diabetic testing supplies, or making referrals to community agencies that can support patients with the financial burdens of their condition, such as finding and paying for transportation to get to dialysis treatment, or paying for medications.
Within these tasks, medical social workers regularly consider social determinants of health. Thorough assessments are conducted that evaluate various aspects of the patients’ life, including housing, income, food availability, transportation and support systems. Referrals are made to agencies and programs that can support those who need assistance in one or more of those areas.
Medical social workers don’t recommend skilled nursing facilities that are private-pay only to someone with little to no financial resources. Rather, a referral is made to a facility that provides quality care at a more affordable rate, that accepts insurance, and/or offers a sliding scale fee to those with fewer financial resources.
How social work services reduce healthcare costs
For years, healthcare administrators believed that social work services were just another expense that, while providing good work, social work departments didn’t benefit the health of patients and therefore, could be and were cut back in order to save on costs. Research and real-world experiences quickly determined that this was not the case at all.
Rather, social workers play a huge role not only in improving the overall health of patients, but can also reduce other healthcare costs, making social work departments a vital, necessary component within the healthcare system.
Some of the ways in which access to social work services and programs can reduce healthcare costs include:
- Connecting people with support and services before their health issues become a crisis. For example, ensuring a diabetic patient is educated about their disease and has access to healthy foods, testing strips and insulin can keep their blood sugars under control, and keep them from spiking or dropping too quickly, which can require an emergency room visit and/or hospitalization. It can also prevent future problems that are a direct result of uncontrolled blood sugar, such as leg amputation, which not only has significant costs of surgery and recovery time, building and fitting a prosthesis and extended physical therapy, but also drastically changes the personal life of the patient and may require additional renovations to their home or vehicle to accommodate their new needs. The low cost of education and access can prevent having to pay hundreds of thousands of dollars in the future.
- Preventative healthcare. Access to screening and/or testing has multiple benefits:
- Education is shared about how to prevent certain conditions, which can lead to people making lifestyle changes on their own in an attempt to avoid said conditions. Examples include stopping smoking, eating more fiber, or using protection to avoid sexually transmitted diseases.
- Screening and testing can catch diseases or conditions at earlier stages, which makes them easier to treat (i.e., fewer medications and/or for a shorter duration, or a simple outpatient surgical procedure as compared to one that is more extensive and requires hospitalization) and sometimes have a much better prognosis, reducing long-term costs to both the patient and the healthcare system.
- Education is shared about how to prevent certain conditions, which can lead to people making lifestyle changes on their own in an attempt to avoid said conditions. Examples include stopping smoking, eating more fiber, or using protection to avoid sexually transmitted diseases.
Social workers can partner with community health organizations to implement screening programs. Mobile screening programs such as mobile mammography units travel to rural or underserved areas to provide education, screening and follow up to those without access to these services. As part of the service, social workers can conduct assessments of each participant and make referrals to other local organizations to assist with whatever other social determinants of health needs they may have. Mobile units or programs that take the screening into the community also reduce the burden on local clinics and hospitals, so that their infrastructure isn’t overwhelmed and they can provide quality care for those who do need to be seen.
- Reducing ‘super utilizers’ or ‘frequent fliers’ who use the ER for basic healthcare needs
Social workers have a vast knowledge of community resources. As a result of conducting thorough assessments, medical social workers also understand the needs patients will have after discharge. Connecting local resources to needs is a strength of social workers. Services can be arranged prior to discharge, which means the patient will have support as soon as they return home. Continued follow up by these local programs and services can head off numerous problems that can lead to an unnecessary ER visit, such as to get a prescription refilled. This saves time for both the staff and the patients waiting to be seen in the emergency room, and the cost of providing care for those who truly need to be treated in an emergency situation.
- Prevent costly hospital readmissions
Similar to the above point, by facilitating outpatient follow-up and needed services, social workers can reduce the number of patients that need to be re-hospitalized within 30 days of their discharge. Coordinating services by an agency such as Meals on Wheels can provide another set of eyes on a patient to ensure they have access to meals and the delivery driver can ensure the recipient is up and moving around to answer the door and hasn’t fallen or gotten hurt. Not only is it disruptive to the patient’s life to have to be readmitted for a complication, it costs the healthcare system to provide the needed care. Additionally, these systems are penalized by Medicare if they have too many 30-day readmissions. This means Medicare will reduce payments to hospitals that exceed their quota of 30-day readmissions. This is another example of how paying for social work services upfront can reduce additional costs and in this case, loss of future earnings (reimbursement) for the hospital.
Case studies and research findings
Numerous studies have demonstrated the ways in which increased social work services can reduce the overall healthcare burden. Many of these studies have involved people aged 65 and older, as this population tends to use healthcare more often than younger people, but others have evaluated cost benefits with other populations. Some of these results include:
- By adding social workers to the ER full time, Aurora Sinai Medical Center in Milwaukee, WI saved over $1 million in just 8 months. They selected 39 patients (out of a pool of 313 individuals) who had each been to the ER at least 5 times in the previous 4 months. Social workers spent 8 months working with them to provide direct services, connect them with community agencies and providers and change their habits so that they visited a primary care doctor or urgent care when sick, rather than the ER. Within the first 4 months of this program, ER visits by these 39 patients dropped by 68 percent. Imagine the savings if all 313 super users were able to receive these services!
- In Pennsylvania, a community health worker program focused on addressing social determinants of health for patients of all ages in low-income neighborhoods was implemented. Within one year, there was a 30% reduction in hospital admissions, had a savings of 38% in healthcare costs, and the return on investment was $2.47 for every dollar invested.
- Tran, Zimmerman and Fielding (2017) reported that the State of California spends $6 billion a year on healthcare that does not improve health. They determined that the same amount of funds spent on social determinants of health for one year would prevent 12,300 tobacco-related deaths, help an additional 418,000 students graduate over 10 years and provide full-day preschool for more than 55,000 low-income children for 10 years. Addressing these social determinants of health alone would save $20.5 billion in taxes and healthcare costs, have a $104 billion return to government for costs averted, and a $403 billion return to society.
- Steketee, Ross & Wachman (2017) conducted a systematic review of the effect of social work-involved health services on health and economic outcomes. They found that across studies that served more than 16,000 participants including pregnant and pediatric patients, low-income adults and geriatric patients, cost-savings were consistent across nearly all studies. They stated “the broad health perspective taken by the social work profession for patient, personal and environmental needs may be particularly valuable for achieving goals of cost containment, prevention and population health.”
- Pruitt et al. (2018) reported on a managed care organization’s call center-based social services referral program that focused on addressing social determinants of health, including homelessness, food insecurity and transportation. Costs were reduced within the first 12 month period after the individual’s first referral, and an additional savings of 10 percent was realized in the second year after referrals, for those reporting their social needs had been met.
How to become a medical social worker
Medical social work is an exciting, important, and ever-changing field. If you are interested in learning more about this social work specialization, we have an excellent guide to becoming a medical social worker. A master’s degree, or an MSW, is most often required to become a medical social worker.
If you’re interested in considering the field before earning your degree, look for volunteer opportunities in your local hospital, and see if you can shadow and assist in the social work department to learn more and see firsthand the types of work they do. If the hospital doesn’t allow volunteers to serve within the social work department, volunteer in another department, but connect with some social workers and interview them to learn more about their work.
If you’re already in school and interested in medical social work, if there is a specific health condition you’re interested in, read all you can about the latest innovations and treatments for that condition. Complete your field placement hours in a hospital or clinic. Consider earning a certification if one is available for your area of interest, such as oncology social work.
Summary
Formal research studies and real-life case studies have demonstrated repeatedly the savings that the provision of social work services in addressing social determinants of health has on reducing health care costs. Social workers provide valuable services to patients and families within the healthcare system and help to coordinate care and facilitate communication with outside organizations and agencies that provide additional supportive services.
This leads to decreased costs and lessens the burden on overworked healthcare systems. Social workers are a critical component to ensuring the physical and mental well-being of patients, and they have demonstrated the cost-saving benefits of their work both within and outside the healthcare system.
References
Davis, K. (2015). To lower the cost of health care, invest in social services. Health Affairs Forefront. Retrieved from https://www.healthaffairs.org/do/10.1377/forefront.20150714.049322
National Public Radio (NPR) (2015). A Hospital Reduces Repeat ER Visits By Providing Social Workers. Retrieved from https://www.npr.org/sections/health-shots/2015/10/23/451154605/a-hospital-reduces-repeat-er-visits-by-providing-social-workers
Kangovi, S., Mitra, N., Grande, D., Long, J.A., & Asch, D.A. (2020). Evidence-based community health worker program addresses unmet social needs and generated positive return on investment. Health Affairs, 39(2), 207-213. doi:10.1377/hlthaff.2019.00981
Pruitt, Z., Emechebe, N., Quast, T., Taylor, P., & Bryant, K. (2018). Expenditure reductions associated with a social service referral program. Population Health Management, 21(6), 469-476.
Steketee, G., Ross, A.M., & Wachman, M.K. (2017). Health outcomes and costs of social work services: A systematic review. American Journal of Public Health, 107(Suppl 3), S256-S266. doi:10.2105/AJPH.2017.304004.
Tran, L.D., Zimmerman, F.J., & Fielding, J.E. (2017). Public health and the economy could be served by reallocating medical expenditures to social programs. SSM-Population Health, 3, 185-191. Retrieved from https://www.sciencedirect.com/science/article/pii/S2352827316300970
World Health Organization (n.d.) Social Determinants of Health. Retrieved from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1