Introduction to Case Management
The American healthcare system is a system with many different healthcare providers, insurance companies, specialists, hospitals, clinics, and many other agents that each pedal individual services. A patient may be required to have a referral from their primary healthcare provider to see a specialist for a physical ailment. They may require another referral to another specialist for mental health. As such, primary healthcare providers do not connect but simply refer and suggest other services. The system is fragmented (Alkema et. al, 2003). However, this fragmentation is not merely prevalent in the healthcare system but other large networks of services required for clients to live health productive lives as
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Individuals requiring a range of services that must be individually monitored, who may need support in seeking out services, coordinating their treatment, and then monitoring their treatments and progress, who may have chronic illnesses that must be treated over time and thus requires follow-ups, who may need and advocate or coordinator will all benefit from a case manager. Case management will greatly improve the lives of the most vulnerable groups in a population, “including those at highest risk of institutionalization, with the lowest levels of social support, or with multiple, chronic problems” (Scharlach et. al, 2001). Other criteria, as stated by the CMSA, include “low functional status or cognitive deficits, social issues such as history of abuse, repeated emergency department visits, poor nutritional status, financial issues, health literacy and illiteracy” and more (Standards of Practice for Case Management, 2010). As such, it seems that most people who feel as though they need help in managing their health as well as many who do not know they need help will all benefit from a case management
Historically, case management is a relatively new term. There have, of course, been interventions and assistance for those in need in the past, however the actual concept of case management has only been introduced within the last few decades. Joel Kanter states “Although environmental interventions have been conducted for many years, the term case management did not enter our professional vocabulary until 1976, when it was articulated as a key element of the Principles for Accreditation of Community Mental Health Service Programs, issued by the Joint Commission on Accreditation of Hospitals.” Case management is a complex term, often hard to define, which historically caused issues. No person’s issues are exactly the same, and there was not much of a guideline to address both environmental and psychological components. Finally, as Kanter states, a case management model was created to help alleviate these historical issues. The Case Management Model helped define what case management case, and that there are both psychological and environmental issues that need to be addressed when using case management. The model helped address the issue of case management being a “loose” term, and gave it more definition and structure.
According to the Case Management Society of America, case management is "a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost effective outcomes" (Case Management Society of America [CMSA], 2010). As a method, case management has moved to the forefront of social work practice. The social work profession, along with other fields of study, recognizes the difficulty of locating and accessing comprehensive services to meet needs. Therefore, case managers work with these
Sicko, a film by Michael Moore was released in 2007. The film investigates health care system in the United States. One would definitely get amazed by the facts and figures explained in this documentary. The movie explains failing health care system in the United States. America has advance medical technology, big hospitals, and educated health care professionals, but these facilities are not universal. The film starts by talking about true American stories; what some people have experienced from current health care system, those who had and did not had health insurances. The story starts by Adam, one of 50 million people in America who does not have health insurance. Due to an accident Adam required a medical treatment, but for the reason of not having any insurance he puts stitches on his leg by himself. The second story was about Rick, who accidentally cut the top of his two fingers, middle and the ring while working on the table saw. As a result of not having health insurance, Rick could not put the top of his middle finger back because it was costing 60,000 dollars and he did not had the money. So, he decided to put his ring finger back because it cost 12,000 dollars which he could afford. The movie does not go into the detail of 50 million people who do not have health insurance, but it’s about 250 million Americans who do have health insurance.
Healthcare has now become one of the top social as well as economic problems facing America today. The rising cost of medical and health insurance impacts the livelihood of all Americans in one way or another. The inability to pay for medical care is no longer a problem just affecting the uninsured but now is becoming an increased problem for those who have insurance as well. Health care can now been seen as a current concern. One issue that we face today is the actual amount of healthcare that is affordable. Each year millions of people go without any source of reliable coverage.
Twenty-first century health care system in United States is not only complex, but also profoundly different from "what it used to be." The changes are numerous and represent the major shifts involved in moving from protection and delivery plan, based primarily on what the patient wanted, to a skeptically managed healthcare system. The American health care system has seen drastic changes within couple generations and it continues to evolve.
What Seems To Be The Problem? A discussion of the current problems in the U.S. healthcare system.
When it comes to health matters, everyone becomes attentive. People believe that with good health, one can virtually accomplish anything that they desire. This is the reason to as why health is given all the attention. It is important to have a clear understanding of the meaning of the term health, healthcare and systems that are put in place to facilitate healthcare.
While most countries around the world have some form of universal national health care system, the United States, one of the wealthiest countries in the world, does not. There are much more benefits to the U.S. adopting a dorm of national health care system than to keep its current system, which has proved to be unnecessarily expensive, complicated, and overall inefficient.
An issue that is widely discussed and debated concerning the United States’ economy is our health care system. The health care system in the United States is not public, meaning that the states does not offer free or affordable health care service. In Canada, France and Great Britain, for example, the government funds health care through taxes. The United States, on the other hand, opted for another direction and passed the burden of health care spending on individual consumers as well as employers and insurers. In July 2006, the issue was transparency: should the American people know the price of the health care service they use and the results doctors and hospitals achieve? The Wall Street Journal article revealed that “U.S. hospitals, most of them nonprofit, charged un-insured patients prices that vastly exceeded those they charged their insured patients. Driving their un-insured patients into bankruptcy." (p. B1) The most expensive health care system in the world is that of America. I will talk about the health insurance in U.S., the health care in other countries, Jeremy Bentham and John Stuart Mill, and my solution to this problem.
Shi, L. & Singh, D. A. (2010). Delivering Health Care in America: A System Approach 5th ed. Baltimore, Maryland: Jones & Bartlet
With the United Nations listing health care as natural born right and the escalating cost of health care America has reached a debatable crisis. Even if you do have insurance it's a finical strain on most families.
The US health system has both considerable strengths and notable weaknesses. With a large and well-trained health workforce, access to a wide range of high-quality medical specialists as well as secondary and tertiary institutions, patient outcomes are among the best in the world. But the US also suffers from incomplete coverage of its population, and health expenditure levels per person far exceed all other countries. Poor measures on many objective and subjective indicators of quality and outcomes plague the US health care system. In addition, an unequal distribution of resources across the country and among different population groups results in poor access to care for many citizens. Efforts to provide comprehensive, national health insurance in the United States go back to the Great Depression, and nearly every president since Harry S. Truman has proposed some form of national health insurance.
Barton, P.L. (2010). Understanding the U.S. health services system. (4th ed). Chicago, IL: Health Administration Press.
Overall, case management provides community mental health care to clients who often suffer from severe mental disorders or other various illnesses. Case management practices are person-centered, as they focus on improving individual support systems. These practices also maintain a person in environment framework, which allow
As a case manager we are “to coordinate needed services provided by any number of agencies, organizations, or facilities” (Kirst-Ashman & Hull, 2015, p. 31). Not only did she advocate for health services for Brenna but she also working on her housing issue, helped her set up a monthly food budget, helped her find counseling, and helped her build a support network (Kirst-Ashman & Hull, 2015, p. 32). By providing Brenna with all of these resources the case manager is building up her self-worth and showing her that even though she had some hard times she can survive and make better for herself and her