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Biomedical subjects

S S Sharfstein

Publications and source records attributed to S S Sharfstein.

At least 19 recordsLinked to original sources

Ethics in managed care.

The current era of managed costs and care create ethical dilemmas based on economic constraints and incorporation of principles of distributive justice. Traditional ethical concerns related to confidentiality, conflicts of interest, double agentry, and honesty are complicated by interference in the doctor-patient relationship caused by intrusive utilization management. National health reform must take these issues seriously to ensure that the "cure" promised by such reform efforts is not worse than the disease. The challenge for psychiatrists is to adapt to these constraints without losing site of traditional medical ethical positions. Once the ethics become diseased, no cure may exist at all.

Adult↗

Bob Dorwart's legacy.

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Health Services Research↗

In the year 2099...

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Delivery of Health Care↗

The role of private insurance in financing treatment for depression.

The health care system in the United States is expensive but fails large groups of its citizens, particularly those with serious mental illness. This paper examines the resource implications of adequate treatment for depression. An analysis of the various tasks necessary for a proper treatment program is used to indicate places where the current mechanisms of provision fall short. Appropriate innovations in principles of funding are suggested.

Costs and Cost Analysis↗

Campaign contributions from the American Medical Political Action Committee to Members of Congress. For or against the public health?

BACKGROUND: The American Medical Political Action Committee (AMPAC), the political arm of the American Medical Association (AMA), contributed $2.4 million to candidates for Congress during the 1989-1990 campaign and $2.9 million during the 1991-1992 campaign. It is not known whether these funds preferentially benefited representatives who supported the AMA's positions on public health issues. METHODS: We analyzed AMPAC contributions to members of the House of Representatives during the 1989-1990 and 1991-1992 campaigns according to their votes on three health-related issues: the promotion of tobacco exports, the institution of a mandatory waiting period before a handgun purchase, and the so-called gag rule, which limited physicians' speech on abortion in federally funded clinics. For each issue, we determined whether AMPAC had contributed more on average to opponents or to supporters of the official AMA position. RESULTS: AMPAC contributed more on average to opponents of the AMA positions on all three public health issues. From 1989 to 1992, AMPAC gave significantly larger average contributions to House members who favored tobacco-export promotion than to those opposed it ($11,549 vs. $9,842, P = 0.04) and contributed significantly less on average to supporters of handgun control than to their opponents ($9,022 vs. $11,250, P = 0.001). During the same period, AMPAC's contributions revealed a marked preference for House members who supported the gag rule over those who opposed it ($10,961 vs. $9,611, P = 0.05). House members who supported the AMA positions on all three votes received an average of $8,800 from AMPAC from 1989 through 1992, whereas members who opposed all three positions received an average of $13,270 (correlation between the number of votes for AMA positions and AMPAC contributions, -0.21; P < 0.001). CONCLUSIONS: AMPAC's contributions to members of the House of Representatives belie the AMA positions on some important public health issues.

American Medical Association↗