Social Work, Cost and Health Outcomes: A Systematic Review

Background and Purpose: The continued burden of persistent health inequities, preventable morbidity

and mortality, and the implementation of the Affordable Care Act (ACA) are some of the forces calling

the social work (SW) profession to examine its impact on health outcomes and costs in serving

vulnerable populations (Ruth et al., 2014).  In particular, the ACA presents unprecedented opportunities

for the SW profession to contribute to the creation of a more patient-centered and coordinated health

care system.  However, while the ACA calls for implementation of efficacious interventions that should

include social workers, social workers have not been named as professionals who could be included in

proposed ACA interventions, likely due to limited data on utility of SW, clarity of SW role, and cost-

effectiveness of SW interventions (Rizzo, 2015).  This paper presents findings from a systematic review

of studies examining outcomes and costs of SW interventions focused on improving health.  

Methods: In this paper, we present findings from a systematic review of major health and allied health

databases.  Investigators used the following search term convention: "social work," AND "cost," AND

"health.”  Cochrane Intervention Review methodological standards were applied, and search parameters

were limited to English language articles published from 1994 through 2014. Studies were included if the

abstract indicated (a) evaluation of a “social work” or “social service” intervention; (b) report of physical

health or health-related service utilization outcomes; and (c) an economic component to evaluation.  For

studies that met inclusion criteria, investigators reviewed the full text of the article.  A meta-analysis of

these studies was not possible due to substantial differences in population, problem, and limitations of

study design and methodology.

Results: Of 677 articles identified, only 20 (3%) met all inclusion criteria.  Among these 20, the majority

of interventions were led by other disciplines (85%; N=17), and 35% (N=7) of studies did not clearly

define the SW’s role.  All studies included interventions with populations traditionally conceptualized as

‘high cost’ to society; populations included geriatric, pregnant or parenting women, pediatrics, and

vulnerable adults (e.g., homeless).  The majority of qualifying studies were conducted in hospital

settings with geriatric populations.  Most studies indicate that inclusion of SW services are associated

with improved health outcomes, reduced costs, and more efficient and appropriate service utilization.

However, analysis revealed wide variability in SW role and service provided.  In addition, the economic

evaluation (EE) methods utilized in these studies were limited primarily to cost savings, cost

effectiveness, and cost utility.  Moreover, with only 20 studies to date, this body of literature is

inadequate to make the case for the value of SW services to address health needs.

Conclusions and Implications: Social workers have a long history of advocating for disenfranchised

populations and are trained to navigate the service systems that provide resources to promote

individual and community health.  As other disciplines are poised to assume traditional social work

functions, studies employing contemporary EE methods that yield data that enable effective adoption

and long-term maintenance of SW interventions must be prioritized. Guidelines for such studies are

recommended.