Caring for "Super‐utilizers": Neoliberal Social Assistance in the Safety‐net. (29th October 2018)

• Record Type: Journal Article
• Authors: Fleming, Mark D.; Shim, Janet K.; Yen, Irene; Van Natta, Meredith; Hanssmann, Christoph; Burke, Nancy J.
• Is Part Of: Medical anthropology quarterly. Volume 33:Number 2(2019)
• Page Start: 173
• Page End: 190
• Publication Date: 2018-10-29
• Subjects: super‐utilizers -- cost effectiveness -- neoliberalism -- justice -- social determinants of health; Medical anthropology -- Periodicals; Anthropology -- Periodicals; Antropología médica -- Publicaciones periódicas; Anthropologie médicale -- Périodiques; Médecine sociale -- Périodiques; Ethnomédecine -- Périodiques; Medische antropologie; Anthropologie médicale; Computer network resources; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 306.461
• DOI: 10.1111/maq.12481
• Languages: English
• ISSNs: 0745-5194

Abstract

Abstract: Hospitals throughout the United States are implementing new forms of care delivery meant to address social needs for structurally vulnerable patients as a strategy to prevent emergency department visits and hospitalizations and to thereby reduce costs. This article examines how the deployment of social assistance within a neoliberal institutional logic involves the negotiation and alignment of economistic values with ethics of care. We focus on care practices meant to stabilize the socioeconomic conditions of the most expensive patients in the health care system—the "super‐utilizers"—through the provisioning of basic resources such as housing, food, transportation, and social support. These patients typically suffer from multiple chronic illnesses accompanied by conditions of poverty, housing and food insecurity, exposure to violence and trauma, and associated substance use and mental health problems. We offer an account of how practices of social assistance are being forged within contexts defined by neoliberal governance.